Fitness and healthy lifestyle 

Gestational pyelonephritis in pregnant women

On the way from a positive pregnancy test to the delivery room, the mother-to-be faces many pitfalls and obstacles. One of them is pyelonephritis of pregnancy, also known as gestational pyelonephritis. Today we will talk about the features of the course of pyelonephritis during pregnancy, as well as the causes, symptoms and methods of treatment of this disease.

Why does pyelonephritis occur during pregnancy

Pyelonephritis is an infectious disease of the kidneys, and the inflammatory process can be caused not only by microorganisms that have entered the internal organs from the external environment, but also by bacteria that are permanent residents of the human body.

Common causative agents of pyelonephritis are:

  • Staphylococci;
  • Enterococci;
  • coli;
  • Proteus;
  • Pseudomonas aeruginosa.

As a rule, pathogens enter the kidneys by the hematogenous route from foci of infection already existing in the body. Pyelonephritis during pregnancy rarely occurs as a result of infection through the urinary tract (urethra, bladder). At the same time, there are a number of factors that contribute to the development of this disease in expectant mothers:

  1. A change in the hormonal background in a woman's body begins from the moment of conception, and by the 8-12th week of gestation, the tone of the ureters decreases, and their length and width increase as a result of the action of progesterone and other hormones. The consequence of this process is stagnation of urine and an increased risk of infection. In women who have encountered this problem before, against the background of such stagnation, an exacerbation of chronic pyelonephritis during pregnancy may occur;
  2. The larger the uterus becomes, the more it compresses the urinary tract. This is especially acute in the case of an anatomically narrow pelvis in a pregnant woman, multiple pregnancy or a fetus that is too large;
  3. Hormonal changes lead to the expansion of the ovarian veins, they begin to compress the ureter. Due to the anatomical features of the structure of the internal organs, the right kidney most often suffers from such compression. The outflow of urine is disturbed, the renal pelvis is stretched up to hydronephrosis. All this together contributes to the occurrence of pyelonephritis during pregnancy;
  4. Estrogens, actively produced by the placenta, contribute to the development of pathogenic flora, in particular E. coli.

Symptoms of pyelonephritis in pregnant women

In the case of an acute form of the disease, the expectant mother can suspect pyelonephritis in herself by the following symptoms:

  • Sharp or dull pain in the lumbar region, aggravated by bending forward;
  • Change in color of urine. It acquires a reddish tint, a sharp unpleasant odor and becomes cloudy;
  • Increase in body temperature up to 38-40 ° C;
  • Nausea, in some cases vomiting;
  • Chills;
  • Decreased appetite;
  • General weakness.

Chronic pyelonephritis during pregnancy for a long time can occur without severe symptoms. The latent form, as a rule, is accompanied by a slight increase in body temperature, while recurrent chronic pyelonephritis is manifested by general symptoms (high fever, weakness, back pain).

Features of the treatment of pyelonephritis during pregnancy

The first and main task of physicians in such a situation is to restore the outflow of urine from the pelvis. This can be done by easing the pressure of the uterus on the kidneys and ureters. For this purpose, positional therapy is used. It is undesirable for a woman to sleep on her back, the best option is on her left side. During the day, you should repeatedly occupy the knee-elbow position and linger in this position from 5 to 15 minutes - this improves the outflow of urine.

When the outflow of urine is restored or not disturbed, the treatment of pyelonephritis during pregnancy is carried out with the help of antibiotics, herbal remedies, antispasmodics and other necessary medicines. Therapy is prescribed by a doctor on an individual basis.

So, with the onset of cystitis, it is usually possible to get by with phytotherapy (collections of kidney herbs, kidney tea, rosehip or lingonberry leaf decoction). In the first trimester, when the formation of the placenta has not yet been completed, antibiotics are prescribed in exceptional cases. For the treatment of acute pyelonephritis during pregnancy, antibiotics of the penicillin group, aminoglycosides, cephalosporins and macrolides can be used. Tetracyclines and streptomycins are strictly forbidden for expectant mothers. The selection of the drug occurs after determining the category of the pathogen and its sensitivity to certain antibiotics. The course of treatment is supplemented with sedative tinctures of valerian or motherwort, as well as vitamins of the PP, B and C groups in order to prevent miscarriage.

As for the chronic form of pyelonephritis during pregnancy, treatment is usually transferred to the postpartum period, but the patient's condition is monitored more closely (blood and urine tests are prescribed more often than healthy pregnant women).

Consequences of pyelonephritis during pregnancy and its effect on the fetus

Future mothers who are faced with an inflammatory process of the kidneys are concerned about the question: is pyelonephritis dangerous during pregnancy? Of course, if you let the disease take its course and do not consult a doctor, the probability of an unfavorable outcome is quite high. Inflammation can deepen into the tissues, which threatens glomerulonephritis, which can eventually turn into kidney failure. In rare cases, phlegmon or kidney abscess may develop. Despite the fact that this complication is relatively rare, no one wants to get into sad statistics.

All this concerns the health of the woman herself, but it must be understood that the child will suffer from the disease first of all. Often the consequence of pyelonephritis during pregnancy is intrauterine infection of the fetus. It also happens that inflammation of the kidneys leads to premature onset of labor and spontaneous abortion.

In newborns, the consequences of intrauterine infection can be different. While some children develop normal conjunctivitis, which does not pose a threat to life, others are born with severe infectious lesions of vital organs.

Sometimes pyelonephritis during pregnancy leads to intrauterine hypoxia, as a result of which the fetus receives less oxygen than necessary. In this case, children are delayed in development, are born with low weight.

Prevention of pyelonephritis in pregnant women

First of all, pyelonephritis occurs in people with weakened immune systems. And since all pregnant women have a decrease in immunity (otherwise the bearing of a fetus that is genetically alien to the female body would be impossible), the conclusion is simple: be attentive to yourself. To avoid pyelonephritis during pregnancy, try to dress warmly, avoid hypothermia, exclude fried foods, pickles and smoked meats from the menu, drink more fluids, follow the rules of personal hygiene, and most importantly, do not forget to go to the toilet every 3-4 hours.

Happy pregnancy and easy childbirth!

Text: Inga Stativka

4.79 4.8 out of 5 (24 votes)

Pyelonephritis during pregnancy (especially with purulent-destructive lesions of the kidneys) has been recorded much more often in recent years than in pregnant women in other countries.

The increase in the prevalence of pyelonephritis during pregnancy and its complications is associated with unfavorable environmental and social factors that create conditions for reducing the protective mechanisms of a pregnant woman. Overwork, beriberi, decreased immunity, concomitant infectious diseases and other factors also contribute to their breakdown.

ICD-10 code

N10 Acute tubulointerstitial nephritis

N11 Chronic tubulointerstitial nephritis

N12 Tubulointerstitial nephritis, not specified as acute or chronic

Causes of pyelonephritis during pregnancy

Pyelonephritis during pregnancy is classified as a disease that has an adverse effect on both the mother's body and the developing fetus. Its occurrence can lead to such serious complications as purulent-necrotic kidney damage and sepsis. With pyelonephritis during pregnancy, the likelihood of premature birth, miscarriage, intrauterine death of the fetus and other obstetric complications increases. When examined in the long term after suffering pyelonephritis during pregnancy, many women find chronic pyelonephritis, nephrolithiasis, nephrosclerosis, arterial hypertension, etc.

Acute pyelonephritis can occur during pregnancy, childbirth and the immediate postpartum period, and therefore this complication is most often called acute gestational pyelonephritis.

Allocate acute gestational pyelonephritis of pregnant women (found most often), women in labor and puerperas (postpartum pyelonephritis).

Up to 10% of pregnant women with acute pyelonephritis suffer from purulent-destructive forms of the disease. Carbuncles, their combination with apostemes and abscesses predominate among them. Most pregnant women develop unilateral acute pyelonephritis, while the right-sided process is detected 2-3 times more often than the left-sided one. Currently, pyelonephritis ranks second in frequency among extragenital diseases in pregnant women. Pyelonephritis during pregnancy is more likely to affect women during their first pregnancy (70-85%) and primiparous than multiparous. This is explained by the lack of adaptation mechanisms to immunological, hormonal and other changes inherent in the body of a woman during the gestational period.

More often pyelonephritis during pregnancy occurs in the II and III trimesters of pregnancy. The critical periods of its development are considered to be the 24-26th and 32-34th weeks of pregnancy, which can be explained by the peculiarities of the pathogenesis of the disease in pregnant women. Less commonly, pyelonephritis during pregnancy manifests itself during childbirth. Pyelonephritis of puerperas usually occurs on the 4-12th day of the postpartum period.

The causes of pyelonephritis during pregnancy are varied: bacteria, viruses, fungi, protozoa. Most often, acute pyelonephritis during pregnancy is caused by opportunistic microorganisms of the intestinal group (E. coli, Proteus). In most cases, it occurs as a continuation of childhood pyelonephritis. The activation of the inflammatory process often occurs during puberty or at the beginning of sexual activity (in the event of defloration cystitis and pregnancy). The etiological microbial factor is the same for all clinical forms of pyelonephritis during pregnancy, and a history of urinary tract infection occurs in more than half of women suffering from pyelonephritis during pregnancy.

Asymptomatic bacteriuria found in pregnant women. is one of the risk factors for the development of the disease. The bacterial agent does not directly cause acute pyelonephritis, but bacteriuria in pregnant women can lead to pyelonephritis during pregnancy. Asymptomatic bacteriuria is noted in 4-10% of pregnant women, and acute pyelonephritis is found in 30-80% of the latter. Bacteriuria in a pregnant woman is one of the risk factors for the development of pyelonephritis in newborns. It is dangerous for the mother and fetus, as it can lead to premature birth, preeclampsia and fetal death. It is known that the urine of a pregnant woman is a good breeding ground for bacteria (especially E. coli). That is why the timely detection and treatment of bacteriuria is of particular importance for the prevention of possible complications.

The incidence of asymptomatic bacteriuria in pregnant women is affected by a woman's sexual activity before pregnancy, the presence of various malformations of the urinary tract, and personal hygiene.

Pathogenesis

Various factors play a role in the pathogenesis of pyelonephritis during pregnancy, while the mechanisms of hemo- and urodynamic disorders may vary depending on the timing of pregnancy. An important role in the pathogenesis of pyelonephritis during pregnancy belongs to violations of the urodynamics of the upper urinary tract, the causes of which can be both hormonal and compression factors. In the early stages of pregnancy, a change in the ratio of sex hormones is noted, followed by a neurohumoral effect on alpha and beta adrenoreceptors, leading to a decrease in the tone of the upper urinary tract. The leading pathogenetic factor of pyelonephritis during pregnancy in later pregnancy is the mechanical pressure of the uterus on the ureters.

In addition to the above mechanisms, an important role in the development of pyelonephritis during pregnancy is played by urodynamic changes in the upper urinary tract, vesicoureteral-pelvic reflux, suppression of the immune system and genetic predisposition.

Dilatation of CHLS is noted from the 6-10th week of pregnancy and is observed in almost 90% of pregnant women. It is during these periods that hormonal dissociation occurs: the content of estrone and estradiol in the blood increases significantly at the 7-13th week, and progesterone - at the 11-13th week of pregnancy. At the 22-28th week of pregnancy, the concentration of glucocorticoids in the blood increases. It has been established that the effect of progesterone on the ureter is similar to beta-adrenergic stimulation and leads to hypotension and dyskinesia of the upper urinary tract. With an increase in the level of estradiol, alpha receptor activity decreases. Due to the imbalance of hormones, a disorder in the urodynamics of the upper urinary tract occurs, the tone of the PCS and ureters decreases, and their kinetic reaction slows down.

Violation of the outflow of urine due to atony of the urinary tract leads to the activation of pathogenic microflora, and possible vesicoureteral refluxes in this case contribute to the penetration of microorganisms into the interstitial substance of the medulla of the renal parenchyma.

Thus, in pregnant women, inflammatory changes in the kidneys are secondary and are associated with impaired urodynamics of the upper urinary tract due to hormonal imbalance.

A change in the concentration of estrogen contributes to the growth of pathogenic bacteria, and especially E. coli, which is caused by a decrease in the function of lymphocytes. In this case, pyelonephritis, as such, may not be, only bacteriuria occurs. In the future, against the background of a violation of the urodynamics of the upper urinary tract, pyelonephritis develops. An increase in the concentration of glucocorticoids in the blood at the 22-28th week of pregnancy contributes to the activation of the latent inflammatory process that began earlier in the kidneys.

In late pregnancy, a violation of the outflow of urine from the kidneys leads to compression of the enlarged uterus of the lower ureters (especially the right one). Violations of the urodynamics of the urinary tract in the second half of the time, when acute pyelonephritis most often occurs, most of the second is explained by the dynamic anatomical and topographic relationships between the anterior abdominal wall, the uterus with the fetus, the pelvic bone ring and the ureters.

Compression of the ureter enlarged and rotated around the longitudinal axis to the right of the uterus contributes to the dilatation of the upper urinary tract and the development of pyelonephritis. It was found that the expansion of the upper urinary tract occurs already at the 7-8th week. pregnancy, when there is still no mechanical effect of the pregnant uterus on the ureter. It is believed that the greater the degree of dilatation of the upper urinary tract, the higher the risk of developing pyelonephritis during pregnancy. To some extent, a pronounced expansion of the pyelocaliceal system and the ureter to the intersection with the iliac vessels is observed in 80% of pregnant women and in 95% of nulliparous women.

Violation of the urodynamics of the upper urinary tract in pregnant women is often associated with the presentation of the fetus. So, for example, compression of the ureters is noted in most pregnant women with head presentation of the fetus and is not recorded with the gluteal or transverse position of the latter. In some cases, violation of the passage of urine from the upper urinary tract in pregnant women may be associated with right ovarian vein syndrome. In this case, the ureter and the right ovarian vein have a common connective tissue sheath. With an increase in the diameter of the vein and an increase in pressure in it during pregnancy, the right ureter is compressed in the middle third, leading to a violation of the outflow of urine from the kidney. The expansion of the right ovarian vein may be due to the fact that it flows at a right angle into the renal vein. Right ovarian vein syndrome explains the more common development of acute right-sided pyelonephritis in pregnant women.

Vesicoureteral-pelvic reflux is one of the pathogenetic mechanisms for the development of pyelonephritis during pregnancy. Vesicopelvic reflux is noted in almost 18% of clinically healthy pregnant women, while in pregnant women who have previously had acute pyelonephritis, its prevalence is more than 45%.

Recent studies have shown that both hormonal discorrelation and damage to the basement membranes of urinary tract leiomyocytes at all levels lead to failure of the vesicoureteral segment and the occurrence of vesicoureteral reflux in pregnant women. Rupture of the arch of the calyx is a consequence of pelvic-renal reflux and urinary infiltration of the interstitial tissue of the kidney and urinary sinus resulting from this, accompanied by acute circulatory disorders in the kidney and hypoxia of the organ, which also creates favorable ground for the development of pyelonephritis.

Normally, when the bladder is filled naturally to the physiological urge to urinate, the tension of the abdominal press and the emptying of the bladder does not cause dilatation of the pyelocaliceal system, i.e. no reflux.

According to ultrasound, the following types of vesicoureteral reflux in pregnant women are distinguished:

  • with tension of the abdominal press and filling of the bladder before the onset of a physiological urge or after urination, an expansion of the pyelocaliceal system is noted, but within 30 minutes after emptying the pelvicalyceal system, the kidney is completely reduced;
  • with tension of the abdominal press and filling of the bladder before the onset of a physiological urge or after urination, an expansion of the pyelocaliceal system is noted, but within 30 minutes after emptying the pelvicalyceal system, only half of the original size is emptied;
  • the pyelocaliceal system is expanded before urination, and after it the retention increases even more and does not return to its original dimensions after 30 minutes.

During pregnancy, restructuring of the lymphoid organs occurs, which is associated with the mobilization of suppressor cells. Pregnancy is accompanied by involution of the thymus gland, a decrease in the mass of which by 3-4 times compared with the initial one occurs already by the 14th day of pregnancy. Hypotrophy of the gland persists for more than 3 weeks after delivery.

Not only the number of T cells is significantly reduced, but also their functional activity, which is associated with direct and indirect (through the adrenal glands) effect of steroid sex hormones on it. In pregnant women suffering from acute pyelonephritis, a decrease in the number of T-lymphocytes and an increase in the content of B-lymphocytes are more pronounced than in women with a normal pregnancy. Normalization of these indicators in the course of treatment can serve as a criterion for recovery. In pregnant women with acute pyelonephritis, not only a decrease in the phagocytic activity of leukocytes and a phagocytic index is noted, but also an inhibition of nonspecific protective factors (a decrease in the content of complement components and lysozyme).

In the immediate postpartum period, not only the same risk factors for the development of acute pyelonephritis persist, as during pregnancy, but new ones also arise:

  • slow contraction of the uterus, capable of creating compression of the ureters for another 5-6 days after birth;
  • pregnancy hormones that remain in the mother's body up to 3 months after childbirth and support the dilatation of the urinary tract;
  • complications of the postpartum period (incomplete placental abruption, bleeding, hypo- and atony of the uterus);
  • inflammatory diseases of the genital organs:
  • urological complications of the early postpartum period (acute urinary retention and prolonged bladder catheterization).

Quite often, acute postpartum pyelonephritis is found in puerperas who have had acute gestational pyelonephritis during pregnancy.

Symptoms of pyelonephritis during pregnancy

The symptoms of pyelonephritis during pregnancy have changed in recent years, making early diagnosis difficult. Symptoms of acute pyelonephritis of pregnant women are due to the development of inflammation against the background of impaired outflow of urine from the kidney. The onset of the disease is usually acute. If acute pyelonephritis develops before 11-12 weeks of pregnancy, then the general symptoms of inflammation (fever, chills, sweating, high body temperature, headache) predominate in patients. Weakness, adynamia, tachycardia are noted. In the later stages of pregnancy, local symptoms of pyelonephritis during pregnancy also occur (pain in the lumbar region, painful urination, a feeling of incomplete emptying of the bladder, gross hematuria). Pain in the lumbar region can radiate to the upper abdomen, groin, labia majora.

Hectic temperature increase that occurs in patients at certain intervals can be associated with the formation of purulent foci in the kidney and bacteremia. During childbirth, the symptoms of pyelonephritis during pregnancy are veiled by the body's reaction to the birth act. Some women with acute puerperal pyelonephritis are misdiagnosed with endometritis, perimetritis, sepsis, and appendicitis. It usually occurs on the 13-14th day after childbirth and is characterized by tension, pain in the muscles of the right iliac region, radiating to the lower back, high fever, chills, vague symptoms of peritoneal irritation, which often serves as a reason for appendectomy.

Diagnosis of pyelonephritis during pregnancy

The use of many diagnostic methods for acute gestational pyelonephritis during pregnancy is limited. This is especially true for X-ray examinations. Radiation load on the fetus should not exceed 0.4-1.0 rad. However, excretory urography even in this mode poses a serious threat to him. It is known that with irradiation from 0.16 to 4 rad (the average dose is 1.0 rad), the risk of developing leukemia in a child almost doubles, and the risk of developing malignant neoplasms in newborns increases three times or more. Excretory urography is used in pregnant women only in exceptional cases - with extremely severe forms of pyelonephritis during pregnancy. Usually it is prescribed only to those patients who, for medical reasons, will undergo an abortion.

X-ray and radioisotope research methods are recommended to be used only in the immediate postpartum period for the diagnosis of postpartum pyelonephritis.

Laboratory studies are an obligatory method for diagnosing pyelonephritis during pregnancy, their complex includes a general analysis of urine and blood, a bacteriological blood test to determine the degree of bacteriuria and sensitivity of isolated organisms to antibiotics, and the determination of the functional activity of platelets

The most informative and objective criteria for the severity of acute pyelonephritis are indicators of the blood coagulation system and immunological tests. leukocyte index of intoxication and the content of medium molecular weight peptides.

A method for calculating the temperature of kidneys from their microwave radiation is proposed. which is completely harmless to the mother and fetus and can be used as an additional method for diagnosing pyelonephritis during pregnancy.

Instrumental methods for diagnosing pyelonephritis during pregnancy, including catheterization of the ureters and renal pelvis, are rarely used. It is considered dangerous even for a pregnant woman to perform a suprapubic puncture of the bladder to take urine for analysis, which is associated with a possible change in the topographic and anatomical relationships of the urinary and genital organs during pregnancy.

Bladder catheterization is not recommended, since any holding of an instrument through the urethra into the bladder is fraught with infection from the front to the back of the urethra and bladder. However, if for medical purposes it is planned to introduce a ureteral catheter or stent, then preliminary catheterization of the ureters is advisable to obtain urine from the affected kidney (for a selective study).

The leading role in the diagnosis of pyelonephritis during pregnancy belongs to the ultrasound of the kidneys. It allows not only to determine the degree of dilatation of the upper urinary tract and the state of the renal parenchyma. but also to detect indirect signs of vesicoureteral reflux. With ultrasound, a halo of rarefaction around the kidney is determined, limiting its mobility. reduction of dilatation of the upper urinary tract in various positions of the body. The ultrasonographic signs of pyelonephritis during pregnancy include an increase in the size of the kidney, a decrease in the echogenicity of the parenchyma, the appearance of foci of reduced echogenicity of an oval-rounded shape (pyramid) and a decrease in the mobility of the kidney.

Sometimes an increase in the thickness of the kidney parenchyma up to 2.1 ± 0.3 cm and an increase in its echogenicity are noted. With carbuncles and abscesses, the heterogeneity of the parenchyma is determined in combination with the unevenness of its thickness, foci of echogenicity with a diameter of 1.7-2.7 cm. Modern ultrasound devices provide the ability to quantify echo density, which is widely used in the diagnosis of pyelonephritis during pregnancy.

Another method of quantitative assessment is dopplerography with the determination of the index of intensity and pulsation, the systolic-diastolic ratio of the volumetric blood flow velocity and the diameter of the renal artery.

Diagnosis of destructive forms of pyelonephritis during pregnancy presents significant difficulties and is based on clinical, laboratory and ultrasound data analyzed over time. The leading criterion for the severity of the condition is the severity of intoxication. Alarming signs indicating destructive changes in the kidney are considered to be constantly high body temperature, resistant to antibiotic therapy. increase in the concentration of creatinine and bilirubin in the blood. With carbuncle, the kidneys visualize large focal areas of the parenchyma with an increase or decrease in echogenicity (depending on the phase of development of the process) and deformation of the outer contour of the kidney. Kidney abscess is defined as a rounded formation with low echogenicity content.

Treatment of pyelonephritis during pregnancy

In recent years, the frequency of complicated forms of pyelonephritis during pregnancy, requiring surgical treatment, remains high. When examining women in the long term after suffering pyelonephritis during pregnancy, chronic pyelonephritis, nephrolithiasis, arterial hypertension, chronic renal failure and other diseases are often found, so the problems of prevention, timely diagnosis and treatment of pyelonephritis during pregnancy are considered very relevant.

Treatment of pyelonephritis during pregnancy is carried out only in stationary conditions. Early hospitalization of patients improves treatment outcomes.

Therapeutic measures for pyelonephritis during pregnancy begin with the restoration of the outflow of urine from the renal pelvis. Positional drainage therapy is used, for which the pregnant woman is placed on a healthy side or in a knee-elbow position. At the same time, antispasmodics are prescribed: baralgin (5 ml intramuscularly), drotaverine (2 ml intramuscularly), papaverine (2 ml 2% solution intramuscularly).

If there is no effect from the therapy, catheterization of the pelvis is performed, using a ureteral catheter or stent to divert urine. Sometimes percutaneous puncture or open nephrostomy is performed. Percutaneous nephrostomy has certain advantages over internal drainage:

  • form a well-controlled short external drainage channel;
  • drainage is not accompanied by vesicoureteral reflux:
  • Drainage maintenance is simple, and there is no need for repeated cystoscopies to replace it.

At the same time, percutaneous nephrostomy is associated with a certain social exclusion. Against the background of the restoration of the outflow of urine from the pelvis, antibacterial treatment, detoxification and immunomodulatory therapy are carried out. When prescribing antimicrobial drugs, it is necessary to take into account the peculiarities of their pharmacokinetics and possible toxic effects on the mother and fetus. With purulent-destructive forms of pyelonephritis during pregnancy, surgical treatment is performed, more often - organ-preserving (nephrostomy, decapsulation of the kidney, excision of carbuncles, opening of abscesses), less often - nephrectomy.

When choosing a method of drainage of the upper urinary tract for pyelonephritis during pregnancy, the following factors must be considered:

  • the duration of the attack of pyelonephritis;
  • features of microflora;
  • the degree of dilatation of the pyelocaliceal system;
  • the presence of vesicoureteral reflux;
  • terms of pregnancy.

The best results of drainage of the urinary tract are achieved with a combination of positional and antibiotic therapy, satisfactory - with the installation of a stent, and the worst - with catheterization of the kidney with a conventional ureteral catheter (it may fall out, and therefore it is necessary to repeat the procedure many times).

Against the background of the restored outflow of urine from the kidney, conservative treatment of pyelonephritis during pregnancy is carried out, which includes etiological (antibacterial) and pathogenetic therapy. The complex of the latter includes non-steroidal anti-inflammatory drugs (NSAIDs), angioprotectors and saluretics. Consideration should be given to the features of the pharmacokinetics of antibacterial drugs, their ability to penetrate the placenta, into breast milk. In the treatment of pyelonephritis in puerperas, sensitization of the newborn is possible due to the intake of antibiotics with mother's milk. It is preferable for women with pyelonephritis during pregnancy to prescribe natural and semi-synthetic penicillins (devoid of embryotoxic and teratogenic properties) and cephalosporins. In recent years, macrolide antibiotics (roxithromycin, clarithromycin, josamycin, etc.) have received wider use.

Pipemidic acid (urotractin), belonging to the group of quinolones. only a small amount crosses the placenta. The content of the drug in the milk of puerperas 2 hours after taking a dose of 250 mg does not exceed 2.65 μg / ml and then gradually decreases and after 8 hours is not determined at all. Aminoglycosides should be administered with caution and not for more than ten days. Sulfonamides are not recommended for use throughout pregnancy. Gentamicin is prescribed with caution, since damage to the VIII cranial nerve in the fetus is possible.

Treatment of complicated forms of pyelonephritis during pregnancy remains one of the most difficult tasks for urologists and obstetrician-gynecologists. There is no single classification of complications of the disease. In addition, there was a trend towards an increase in the prevalence of purulent-destructive forms of pyelonephritis during pregnancy. among the possible causes of which are frequent infection with highly virulent gram-negative microorganisms, immunodeficiency states, late diagnosis of the disease and untimely initiation of treatment.

An important component of detoxification therapy for complicated forms of pyelonephritis during pregnancy is the use of extracorporeal detoxification methods. such as plasmapheresis. Advantages of the method: ease of implementation, good tolerance by patients, no contraindications to its use in pregnant women. With plasmapheresis, the deficiency of cellular and humoral immunity is eliminated. Already after the first session, in most patients, body temperature returns to normal, the severity of clinical and laboratory signs of intoxication decreases, and health improves; there is a stabilization of the condition of patients, which allows for surgical intervention with minimal risk.

In the complex treatment of pyelonephritis during pregnancy, it is recommended to include ultraviolet irradiation of autologous blood. The most effective is the earlier application of this method (before the transition of the serous stage of the disease to the purulent).

Indications for surgical treatment of pyelonephritis during pregnancy:

  • ineffectiveness of antibiotic therapy for 1-2 days (increase in leukocytosis, increase in the number of neutrophils in the blood and ESR, increase in creatinine concentration);
  • obstruction of the urinary tract due to stones;
  • the impossibility of restoring the urodynamics of the upper urinary tract.

Only the performance of early and adequate operations in pregnant women with purulent-destructive pyelonephritis can stop the infectious and inflammatory process in the kidney and ensure the normal development of the fetus.

The choice of the method of operation depends on the characteristics of the clinical course of pyelonephritis during pregnancy: the severity of intoxication, damage to other organs, macroscopic changes in the kidneys. Timely implementation of surgical intervention in most cases allows you to save the kidney and prevent the development of septic complications.

With purulent-destructive changes limited to 1-2 segments of the kidney, nephrostomy and decapsulation of the kidney are considered an adequate method of surgical treatment. With widespread purulent-destructive damage to the organ and severe intoxication that threatens the life of the pregnant woman and the fetus, nephrectomy is most justified. In 97.3% of pregnant women, the use of various surgical interventions made it possible to achieve a clinical cure for purulent-destructive pyelonephritis.

Termination of pregnancy with pyelonephritis during pregnancy is rarely carried out. Indications for it:

  • fetal hypoxia;
  • acute renal failure and acute liver failure;
  • intrauterine fetal death;
  • miscarriage or premature birth;
  • hypertension in pregnancy;
  • severe preeclampsia (with unsuccessful therapy for 10-14 days).

Recurrence of the disease is noted in 17-28% of women with inadequate or late treatment. For the prevention of recurrence of the disease, dispensary observation of women who have had pyelonephritis during pregnancy, a thorough examination of them after childbirth, which allows timely diagnosis of various urological diseases, prevent complications, and plan subsequent pregnancies, is recommended.

Pyelonephritis is a pathology of the kidneys of infectious origin, in which the structure of the organ is disturbed. Against the background of inflammation, the outflow of urine worsens, the disease is accompanied by pain, sometimes high fever. Pyelonephritis during pregnancy occurs frequently, may be primary, but more often an exacerbation of chronic inflammation of the kidneys is diagnosed. How to treat pyelonephritis during pregnancy? How dangerous is the disease for mother and child?

Pyelonephritis in pregnant women is diagnosed in about 10% of women. The main reasons are weakened immunity, uterine pressure on the kidneys, hormonal changes. The ICD-10 code is O23.0 (kidney infection during pregnancy).

As the fetus grows, the uterus increases in size - under pressure, the anatomical structure of the kidneys changes, blood circulation worsens, urine passes worse. Against the background of hormonal changes in the body, muscle tone changes - urodynamics are disturbed, urine from the bladder is thrown back into the kidneys. If pathogenic microorganisms are present in the urine, the inflammatory process in the kidneys begins.

Important! Any infectious disease can cause inflammation in the organs of the genitourinary system.

Inflammation of the kidneys in pregnant women is called gestational pyelonephritis - the disease develops during the bearing of a child, it may appear a few days after childbirth. Most often, the inflammatory process is localized in the right kidney.

Most often, gestational pyelonephritis occurs in primiparous women, with polyhydramnios, bearing two or more children, and a large fetus. The disease often proceeds without clear symptoms, the signs are similar to placental abruption, the threat of miscarriage. The diagnosis can be established only after the tests.

Indications for hospitalization for pyelonephritis in pregnant women:

  • acute pyelonephritis, exacerbation of the chronic form;
  • kidney failure;
  • preeclampsia, which develops against the background of inflammation of the kidneys;
  • the threat of miscarriage, premature birth;
  • if the tests showed a deterioration in the condition of the fetus.

Pyelonephritis in the first trimester is more pronounced than in late pregnancy. Adequate treatment at the initial stage of the disease will help to quickly eliminate the inflammatory process, the risk of complications is minimal. If gestational pyelonephritis occurs against the background of hypertension, anemia, functional impairment of the kidneys, this poses a serious threat to the life and health of the mother and child.

Pyelonephritis is an infectious disease that occurs against the background of infection with Escherichia coli, bacteria. With blood flow in the ascending or descending pathways, pathogenic microorganisms penetrate the kidneys. The weakened immunity of a pregnant woman cannot fight them, inflammation develops.

Acute pyelonephritis is accompanied by severe pain in the lumbar region, which radiates to the leg, abdomen, buttocks. Urination becomes painful, the temperature rises sharply, sweating increases. In nulliparous women, the disease can occur at 16-20 weeks, in multiparous women - at 25-32.

  • an increase in body temperature to 38–39 degrees;
  • urine becomes cloudy;
  • persistent lower back pain on one or both sides;
  • chills, pain in the joints, muscles.

Chronic pyelonephritis occurs without any special symptoms, which can be very dangerous for a pregnant woman. A clinical analysis of blood and urine will help establish the diagnosis. The development of an inflammatory process in the kidneys may be indicated by dull pain in the lumbar region, the presence of protein in the urine.

Important! Exacerbation of chronic pyelonephritis during pregnancy can cause miscarriage, premature delivery, fetal death in the womb.

Important! Pyelonephritis is subject to mandatory treatment during pregnancy - antibiotics cause less harm. Rather than an inflammatory process in the kidneys.

How does pyelonephritis affect pregnancy? In pregnant women with inflammation of the kidneys, gestosis almost always occurs in severe form - this can cause serious consequences for the child.

What threatens pyelonephritis during pregnancy:

  • premature termination of pregnancy - a constant or severe pain syndrome stimulates contraction of the uterine myometrium;
  • infection of the fetus in the womb - in the early stages of pregnancy, the placenta is not yet fully formed, the infection penetrates the tissues of the fetus, developmental pathologies occur;
  • oxygen starvation - against the background of pathological changes in the kidneys, hypoxia and fetal asphyxia occur.

If a woman has had pyelonephritis during pregnancy, then newborns often have low weight, prolonged jaundice, hypothermia, and pathologies of the central nervous system.

Important! The consequence of pyelonephritis in the early stages is the death of a child in the early postpartum period.

Since inflammation of the kidneys often develops into a chronic form, pregnancy after pyelonephritis takes place under the constant supervision of a doctor, a woman is recommended to go to the hospital in the first and third trimester.

Diagnostics

Early diagnosis helps to minimize the negative consequences of the disease, to transfer the pathology to the stage of stable remission. After an external examination and analysis of complaints, the doctor prescribes a comprehensive, comprehensive examination.

Diagnostic methods:

  • clinical analysis of urine - the presence of protein, bacteria, a high level of leukocytes testifies to the inflammatory process;
  • urine analysis according to Nechiporenko, according to Zimnitsky - shows the content of leukocytes, the presence of protein and blood impurities;
  • urine culture to identify the type of pathogenic microorganisms - carried out three times;
  • a clinical blood test - inflammation is evidenced by high ESR, low hemoglobin, a high content of immature leukocytes;
  • Ultrasound conventional and with Doppler.

If pyelonephritis is suspected, the gynecologist gives a referral for tests and a consultation with a nephrologist. Further treatment of renal inflammation will take place in a hospital under the supervision of both specialists.

Important! Pyelonephritis does not apply to the main indications for caesarean section.

Features of treatment in pregnant women

With pyelonephritis of the kidneys, pregnant women must observe bed rest, avoid stress, heavy physical exertion. To improve the outflow of urine, you need to lie down on the side opposite to the inflamed kidney several times a day - while the legs should be slightly higher than the head. If there is no improvement within 24 hours, the woman will have a catheter.

Antibiotics for the treatment of inflammation of the kidneys are used without fail, their choice depends on the duration of pregnancy, the form and severity of the disease. Additionally, uroantiseptics, painkillers, antispasmodics are prescribed. The treatment regimen is prescribed by the doctor on an individual basis.

The main drugs for the treatment of inflammation of the kidneys:

  1. In the first trimester, antibiotics are given as a last resort, as the placenta does not yet fully protect the fetus. During this period, it is allowed to use antibiotics of the penicillin group - Ampicillin, Amoxiclav.
  2. In the second trimester, it is allowed to use stronger antibacterial agents from the group of cephalosporins II, III generation - Cefazolin, Suprax. These funds can be taken up to 36 weeks, the duration of therapy is 5-10 days.
  3. From 16 weeks, if necessary, Nitroxoline can be used.
  4. With kidney damage by staphylococci, macrolides can be used - Sumamed, Erythromycin.

Important! It is strictly forbidden to carry out treatment during pregnancy with fluoroquinolones (Nolicin), drugs based on tetracycline, you can not take Biseptol, Levomycitin.

Of great importance during treatment is proper nutrition, compliance with the drinking regimen. A diet for pyelonephritis in pregnant women implies a complete rejection of spicy, salty, fatty, smoked, fried foods. It is not recommended to eat foods that irritate the walls of the bladder - radishes, spinach, sorrel. Bread is better to eat a little dried, preference is given to products made from wholemeal flour.

You need to drink at least 2 liters of fluid per day. The best drinks for pregnant women are cranberry juice, rosehip broth, still mineral water.

Treatment with folk remedies

Phytotherapy will help enhance the effectiveness of medicines; for the treatment of pyelonephritis, plants are used that have diuretic and anti-inflammatory properties.

How to treat pyelonephritis with herbs? First you need to remember which plants are forbidden to use during pregnancy:

  • juniper berries;
  • parsley root and seeds;
  • bearberry;
  • licorice;
  • yarrow.

A decoction of oats is a universal remedy for treating inflammation of the kidneys. It must be prepared from cereals - pour 180 g of cereals into 1 liter of water, simmer for 2-3 hours over low heat. Take oatmeal medicine on an empty stomach, 120 ml 2-3 times a day.

Pumpkin is a healthy vegetable with a powerful anti-inflammatory effect. From it you need to make juice, cook porridge, eat it raw and boiled.

Rosehip broth is an indispensable drink for pregnant women, which strengthens the immune system, has a diuretic and anti-inflammatory properties. In 1 liter of boiling water, pour 100 dried berries, simmer over low heat for 5 minutes in a closed container. Infuse for 3 hours, drink the entire portion of the broth during the day.

Infusion of thyme helps to quickly eliminate pain and inflammation. Pour 220 ml of boiling water over 5 g of dry raw materials, leave for 20 minutes. Take in strained form, 15 ml 3-4 times a day. The duration of treatment is 7-10 days.

Prevention

Pregnant women should know not only how to treat pyelonephritis, but also how to prevent the onset of the disease, its exacerbation. You need to regularly visit a gynecologist, take urine and blood tests. To prevent exacerbation in chronic renal inflammation from 12–13 weeks, you can take urological herbal remedies - Kanefron N, Brusniver.

If there is a history of chronic diseases of the urinary system, then a special diet should be followed until the very birth. Pregnant women need to empty their bladder every 3-4 hours to prevent stagnant urine.

It is necessary to avoid hypothermia, not to visit crowded places during epidemics, regularly perform gymnastics for pregnant women, swim, and walk for 30-40 minutes every day.

Pyelonephritis during pregnancy is a difficult and dangerous disease that is dangerous for a woman and a child. It is imperative to treat the disease, since the infection can cause the death of the child. Timely diagnosis, implementation of the doctor's recommendations will help to avoid exacerbation and recurrence of renal inflammation.

Experienced obstetrician-gynecologists know that gestational pyelonephritis in pregnant women is dangerous for both the fetus and the expectant mother. This is a disease in which the pyelocaliceal system of the organ becomes inflamed and the tubules are affected. In the absence of timely assistance, this pathology acquires a protracted course and can cause the development of renal failure.

Pyelonephritis is an infectious disease characterized by inflammation of the interstitial tissue involving the calyces and pelvis in the process. The prevalence of this pathology among pregnant women reaches 7%. There are 3 degrees of severity of pyelonephritis. With a mild form, acute inflammation develops. Complications are absent. With timely treatment, pregnancy and childbirth proceed without complications.

Pyelonephritis of the 2nd degree of severity often occurs in a chronic form. In 20-30% of cases, it leads to complications. The most severe is gestational pyelonephritis of the 3rd degree. Against its background, secondary (symptomatic) arterial hypertension and renal failure develop. In this situation, there is a risk for the child. If the disease is detected before the conception of a child, then pregnancy is not recommended due to the high risk.

Main etiological factors

Gestational pyelonephritis during pregnancy develops for several reasons. The main predisposing factors are:

  • stasis of urine;
  • reflux as a result of a decrease in the tone of the bladder and ureters;
  • infection penetration;
  • hormonal changes;
  • compression of the ureters by an enlarged uterus;
  • urolithiasis disease;
  • violation of blood circulation;
  • cystitis;
  • urethritis;
  • the presence of diabetes;
  • immunodeficiency;
  • dystopia;
  • catheterization.


In most cases, inflammation of the kidneys is detected in the 2nd and 3rd trimesters. Most often, bacteria (E. coli, cocci) act as causative agents of pyelonephritis. Their active distribution is facilitated by an increase in the level of progesterone in the blood. This hormone reduces the tone of the ureters and bladder.

The excretion of urine is difficult. Protective mechanisms do not work, and microbes accumulate, penetrating into the kidneys in an ascending way. Sometimes bacteria spread through the blood and lymph. This is possible in the presence of other infectious diseases. Pyelonephritis in pregnant women occurs when the kidney tissues are squeezed by an enlarged uterus.

Less often, the disease is caused by viruses and fungi. Infection is possible during catheterization. Pyelonephritis often develops in women who do not follow the rules of intimate hygiene, drink little, have STIs and endocrine diseases. The risk group includes women aged 18–30 who have not given birth before.

The pathogenesis of the development of the disease

Inflammation of the kidneys by the type of pyelonephritis has a complex mechanism. It is based on a violation of urodynamics (normal urine flow). Compression and hormonal factors contribute to this. At the beginning of pregnancy, the body changes. The ratio of estrogen and progesterone changes.

The latter acts on adrenoreceptors of the upper urinary organs. This leads to hypotension. Consequence - stagnation of urine. On days 7-13, the production of estradiol increases. It disrupts alpha receptor activity. In late gestation, the main link in the pathogenesis of the development of pyelonephritis is the compression of the kidney tissues by the uterus. The following factors play an important role:

  • hereditary predisposition;
  • decreased immune status;
  • vesicoureteral reflux.

During pregnancy, the activity of lymphocytes decreases. Initially, bacteriuria develops, which, if left untreated, leads to kidney damage. The disease is more often detected in women with head presentation of the fetus. If there is a syndrome of the right ovarian vein, then compression of the middle third of the right ureter occurs. In this case, acute pyelonephritis develops.


Signs of pyelonephritis in pregnant women

The disease most often begins acutely. With pyelonephritis before the 12th week of pregnancy, the following symptoms are observed:

  • fever;
  • increased sweating;
  • chills;
  • tachycardia;
  • adynamia;
  • weakness;
  • unilateral or bilateral lower back pain;
  • strangury;
  • feeling of fullness in the bladder.

Very often inflammation of the kidneys is combined with cystitis and urethritis. Pain in gestational pyelonephritis is unilateral. Only sometimes both kidneys are involved in the process. The pain radiates to the genitals, groin and upper abdomen. It is of varying intensity. Infection always provokes the appearance of symptoms of intoxication.

The purulent-destructive form of the disease proceeds most rapidly. It is characterized by hectic fever. The temperature rises after a certain time. When tapping along the edge of the costal arch, a positive symptom of Pasternatsky is revealed. Sometimes nausea and vomiting occur. Women's appetite worsens.

Urine acquires a reddish tint. This symptom is not always observed. It indicates the appearance of blood in the urine. Urine is cloudy. With a combination of pyelonephritis with cystitis, mictions become frequent. Possible pain in the pubis. The chronic form of the disease is asymptomatic or with a poor clinical picture.

The danger of pyelonephritis for the fetus

What is the effect on the fetus of this disease is not known to everyone. Running pyelonephritis can cause sepsis. This is a dangerous complication in which bacteria and their toxins spread and affect all organs and systems. Microbes cross the placental barrier and can cause miscarriage.

Other negative consequences are intrauterine infection and premature birth. The most dangerous complication is infectious-toxic shock. It develops very rarely. The reason for the violation of the development of the baby can be preeclampsia. This is a complication of pregnancy, characterized by edematous syndrome, high blood pressure and proteinuria. Children born to mothers with pyelonephritis may be weak and premature.

Plan of examination of pregnant women

Treatment of pregnant women should begin after the diagnosis is clarified. The following research will be required:

  • Ultrasound of the kidneys and bladder;
  • general blood analysis;
  • general urine analysis;
  • blood chemistry;
  • chromocystoscopy;
  • catheterization;
  • hormone analysis;
  • Zimnitsky test.


Be sure to assess the condition of the fetus. Cardiotocography, breath-hold tests, Doppler ultrasound, listening to heart rate with an obstetric stethoscope, and phonography are required. You may need a bacteriological analysis of urine. A biochemical study often reveals a high content of creatinine and urea.

The main diagnostic criterion is an increase in the number of leukocytes in the urine. Normally, there are up to 6 of them in the field of view. With pyelonephritis, the appearance of protein and red blood cells is possible. If the disease occurred against the background of nephrolithiasis, then a lot of salts appear in the analysis. Studies with radiation exposure can be used only after childbirth. Many instrumental interventions pose some danger, so laboratory tests are often sufficient.

Treatment methods for pregnant women

Treatment is carried out in a hospital. The main objectives of therapy are:

  • destruction of microbes;
  • restoration of urine outflow;
  • elimination of symptoms;
  • prevention of purulent complications.

Positional drainage therapy is carried out. To restore the outflow of urine, sick women are laid on a healthy side. The foot end of the bed is recommended to be raised. This position reduces pressure on the ureters. In the absence of effect, catheterization is performed. With stagnation of urine may resort to puncture nephrostomy.

During this procedure, drainage is carried out. Sometimes decapsulation is required. It may be needed for purulent complications. In this situation, the attending physician decides on the termination of pregnancy. It all depends on the gestational age. It is almost impossible to cure pyelonephritis without antibiotics.

In the early stages of gestation, penicillins or macrolides are prescribed. These include Oxacillin-Akos, Erythromycin-Lect, Amoxicillin, Ampicillin and Amoxiclav. The doctor must take into account the risk and possible benefits. In the 2nd and 3rd trimesters, antibiotics from the cephalosporin group can be used. Do not use drugs that have an embryotoxic effect. These include tetracyclines and aminoglycosides. In the 2nd trimester, Urotractin or Vero-Pipemidin can be used.


In severe general condition of a pregnant woman, detoxification therapy is performed. Effective solutions Gemodez and Laktasol. With severe pain, antispasmodics or analgesics are indicated. When excited, sedatives are used. In order to improve the immune status, vitamins C, B and PP are prescribed. All patients should adhere to bed rest. Drug therapy lasts 1–1.5 weeks.

At the end of the course of treatment, control tests are carried out. To speed up recovery, herbal medicines are used. They do not contain synthetic substances harmful to the fetus. Such a drug is Kanefron N. It is available in the form of a solution and dragee. This medicine not only helps to cope with the infection, but also prevents the formation of stones. Kanefron H has diuretic and anti-inflammatory effects.

Additional therapeutic measures

In chronic pyelonephritis, spa treatment is useful. During an exacerbation, rest should be observed, and during remission, you need to move more. All patients should follow these guidelines:

  • give up wine and other alcoholic beverages;
  • drink more berry fruit drinks and compotes;
  • stick to a diet.

From the menu you need to exclude spicy dishes, fatty and fried foods. To cleanse the kidneys, it is recommended to drink more. In the pharmacy network there are various kidney fees in the form of tea. Before using them, it is recommended to consult a doctor. Of the herbal remedies for pyelonephritis, lingonberry leaf, chamomile, plantain and rosehip help. With improper treatment, relapses of the disease are possible. They are observed in 15-30% of cases.

Prevention of pyelonephritis during pregnancy

Inflammation of the kidneys is potentially dangerous for the patient and the fetus. The main methods of prevention of pyelonephritis are:

  • elimination of foci of chronic infection;
  • prevention of cystitis and urethritis;
  • treatment of diseases of the genital organs;
  • observance of sterility during catheterization;
  • compliance with the rules of intimate hygiene;
  • frequent change of underwear;
  • taking vitamins;
  • regular walks;
  • hardening;
  • wearing clothes that do not expose the lower back;
  • hypothermia warning;
  • plentiful drink;
  • rejection of bad habits.

All pregnant women should be examined according to the examination calendar. In the case of the development of pyelonephritis, complications and relapses are prevented. It includes complex treatment (taking antibiotics, uroantiseptics, drinking plenty of water). Thus, pyelonephritis is a dangerous disease. If it occurs at an early gestational age, then most drugs are contraindicated, since the laying of fetal tissues is in progress. Completeness, timeliness and safety of treatment are the key to recovery and preservation of the baby.

Photobank Lori

Pyelonephritis affects the internal tissues of the kidney. The disease manifests itself with fever and back pain.
In the analysis of urine with pyelonephritis, the number of leukocytes (immune cells) increases, bacteria and erythrocytes (red blood cells) appear.
Pyelonephritis is treated during pregnancy with antibacterial drugs in tablets. At the same time, measures are taken to remove toxins from the body that the kidneys cannot cope with.

What is pyelonephritis?

Pyelonephritis is an inflammation that mainly affects the tissues lining the inner surface of the kidneys. In addition, their main tissue, the parenchyma, is affected. Most often, pyelonephritis is caused by opportunistic bacteria that are part of the normal human flora, for example, E. coli, enterobacteria, enterococci.

If the woman's immune system is working properly, these microbes live peacefully in the body. In a situation where the body's defenses are weakened, which happens during pregnancy, opportunistic bacteria can become pathogenic and cause problems, including pyelonephritis.

I was diagnosed with pyelonephritis in all three pregnancies in the second half. She was in the hospital, if there were too many edema and she couldn’t cope, at home she drank something diuretic all the time. By the way, in normal life everything is fine with the kidneys. Probably a reaction to pregnancy. It is necessary to monitor the amount of water drunk and “poured out”, follow the diet, and everything will be in relative norm.

Why do women get pyelonephritis more often during pregnancy?

Expectant mothers, in general, are more susceptible to infectious diseases because normal things happen during pregnancy. This is necessary so that the child, whose set of cells is half foreign to the mother's body, is not rejected.

In addition, changes in the functioning of the urinary system occur during pregnancy. The ureters that run from the kidneys to the bladder and the spaces inside the kidneys (the pelvis and renal calyces) dilate, causing large amounts of urine to accumulate in them, which increases the risk of inflammation.

For the same reasons, an exacerbation of latent chronic pyelonephritis can occur during pregnancy. If a woman in her normal state has aggravated the disease several times, “chronic pyelonephritis” will be recorded in her card, and she will be taken more often than usual so as not to miss the onset of an exacerbation.

Symptoms to watch out for

Pyelonephritis most often begins with fever up to 38-40ºС, severe chills, headache, sometimes nausea and vomiting appear.
The characteristic symptoms of the disease are also frequent painful urination and back pain. But sometimes the rise in temperature is small, so even with an indicator of 37.5ºС, if such a jump is combined with pain when urinating or pulling pains in the back, consult a doctor urgently.

Complications of pyelonephritis

If the disease is not treated, dangerous complications are possible, for example, an abscess (cavity with pus) in the kidney or severe preeclampsia. Therefore, pregnant women with acute or chronic pyelonephritis should be under strict medical supervision.

How is pyelonephritis diagnosed during pregnancy?

Doctor's suspicions arise already during the interview and examination of the patient. The infection often moves up the urinary tract, from the bladder to the kidneys, therefore, before the development of pyelonephritis, women often complain of pain when urinating, that is, and only then do they experience discomfort in the back and the temperature rises.

In the general analysis of urine with pyelonephritis, the number of leukocytes is increased, there are erythrocytes, protein and bacteria. In addition, a urine culture is taken from the patient to identify the causative agent of the disease and determine its sensitivity to antibiotics.