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Features of chronic pyelonephritis in pregnant women. Pyelonephritis - an insidious disease during pregnancy

During pregnancy, the load on the kidneys of the expectant mother increases significantly, therefore, diseases associated with inflammatory processes in the excretory system are much more common. Among women diagnosed with pyelonephritis, one in ten is expecting a baby. To avoid possible complications, you need to know what symptoms the disease can manifest in pregnant women. If at least one of them occurs, you must consult a doctor for a thorough diagnosis.

Features of pyelonephritis in pregnant women

Pyelonephritis is characterized by the development of inflammatory processes in the tissues of the kidneys and intrarenal segments. Depending on the characteristics of the course, the disease can be either acute or chronic. The latter is the most dangerous due to the increased likelihood of kidney damage and, as a result, the appearance of serious violations in their work.

In women, while carrying a child, the risk of pyelonephritis increases, since the developing pregnancy affects the state of the urinary system. The cause of the onset of the disease is an infection that has entered the body of the expectant mother. The focus of harmful microbes can be not only in the kidneys or urinary system, but also in the mouth (caries) or on the skin (abscess).

Due to the weakening of immunity during pregnancy, the penetration of infection into the kidneys is much faster and easier. This is also facilitated by a change in hormonal levels and an increase in the level of progesterone, which reduces the tone of the smooth muscles of the internal organs.

Pyelonephritis requires hospitalization and compulsory observation by a doctor

Most often, pyelonephritis is diagnosed in primiparous women. This is because they have firmer abdominal muscles that have not been stretched by previous pregnancies. The musculature does not allow the expanding uterus to bulge outward, which creates unnecessary pressure on the kidneys, in particular, the right one. This causes a violation of full blood circulation and a delay in the timely excretion of urine. The consequence of squeezing the organ is the development of an inflammatory process - pyelonephritis, which begins to manifest itself at the end of the second trimester of pregnancy.

Video: Dr. Berezovskaya - causes of pyelonephritis in a pregnant woman and tests for its diagnosis

Types of pyelonephritis

The disease can take on both an acute and a chronic course, and the latter is most typical for expectant mothers.

In the case of a sluggish form of pyelonephritis, there may be no signs of the disease at all, which is why it is so important to take urine tests throughout pregnancy.

There is an acute form of pyelonephritis, characteristic only for pregnant women, called gestational. This disease is caused by a violation of the outflow of urine from the ureter, which is provoked by the growing uterus. The worst case scenario is the occurrence of gestational pyelonephritis against the background of chronic pyelonephritis, which significantly increases the likelihood of possible complications.

The prerequisites for the development of gestational pyelonephritis are:

  • a history of frequent cystitis or acute pyelonephritis (before pregnancy);
  • detection of bacteria in urine before or during pregnancy;
  • diabetes;
  • genetic predisposition to kidney disease;
  • congenital malformations of the kidneys.

Sometimes pregnancy provokes a "sleeping" disease, and it manifests its symptoms

Symptoms

The acute form of pyelonephritis is the option when a visit to the doctor should be urgent. Usually, the disease manifests itself in primiparous women at 4–5 months of pregnancy, in re-pregnant women at 6–8 months. Signs of the course of the inflammatory process are:

  • a sharp increase in body temperature (38–40 0 С);
  • the appearance of headaches;
  • a feeling of aches in the bones and lower back (more often in the right side, but it can be both in the left and on both sides). Increased pain when trying to bend;
  • increased morning pressure, especially lower (diastolic);
  • cold and damp hands and feet;
  • weakness and loss of appetite;
  • feeling of nausea and chilliness;
  • changes in urine: the appearance of a suspension or sediment, an unpleasant odor, a color change to reddish or pink.

An increase in temperature with pyelonephritis usually occurs towards the night

In the chronic form of the disease, the symptoms are less pronounced, pyelonephritis can be suspected only during the period of exacerbations or during tests and examinations. The pain syndrome is not clearly expressed and can manifest itself only with physical exertion and certain movements. The unpleasant sensations do not last long or are absent altogether, while the pregnant woman feels unwell (fatigue, rapid fatigue, a feeling of freezing) and does not associate her condition with the course of the inflammatory process. Periods of exacerbation are characterized by symptoms similar to the acute form of pyelonephritis.

Diagnosis of pyelonephritis in pregnant women

The correct and timely formulation of the correct diagnosis is very important for the expectant mother and her child. It is especially important to notice chronic pyelonephritis in time, because without treatment, a neglected disease (second and third degree of risk) gives more serious consequences:

  • the development of complications of pregnancy (toxicosis, eclampsia - one of the manifestations of late toxicosis, which consists in a high level of blood pressure), in the most severe cases - up to its loss;
  • difficult delivery;
  • renal failure;
  • arterial hypertension, etc.

Acute pyelonephritis is much easier to diagnose, sometimes the prerequisites for this conclusion follow from the story of the pregnant woman about the symptoms that bother her and are easily recognized during examination. For the final diagnosis or to identify the chronic form of the disease, it is necessary to carry out instrumental and laboratory studies.

Inspection

When examining a pregnant woman, the characteristic signs of pyelonephritis are:

  • pallor of the skin;
  • swelling of the eyelids;
  • pain that occurs when probing the back from the kidneys;
  • positive symptom of Pasternatsky (expressed in the appearance of soreness from the kidneys when tapping in the lumbar region).

With gestational pyelonephritis, pain occurs predominantly on the right side

Analysis of urine

There are several methods for examining urine for an accurate diagnosis of pyelonephritis. Usually, additional tests are ordered after an unsatisfactory general urinalysis (OAM).

OAM helps in the diagnosis of even asymptomatic pyelonephritis. The main indicator of the presence of the disease is an increased number of leukocytes in the urine (leukocyturia), as well as the detection of bacteria (bacteriuria) and protein (proteinuria), which should normally be absent. Even organoleptic signs of urine can indicate the presence of inflammatory processes in the kidneys:

  • color change to dark yellow, sometimes there is a red tint from the appearance of blood in the urine;
  • the appearance of a pungent and unpleasant odor;
  • clouding of urine, suspension or sediment can be observed.

Before passing a urine test, preliminary preparation is necessary: ​​refusal to use coloring products, take medications and hygiene of the genitals

In addition to OAM, the following urine tests are additionally prescribed:

  • a test according to Zimnitsky (the analysis is based on measuring the level of urine density during the day, a deviation from the norm indicates a violation of the kidneys' ability to concentrate urine);
  • analysis according to Nechiporenko (during the analysis, the number of leukocytes, erythrocytes and cylinders in 1 ml of urine is counted. An excess of leukocytes indicates the course of the inflammatory process, an increased number of cylinders - about kidney pathology);
  • urine culture to identify the causative agent of the disease and determine the sensitivity to antibiotics in order to prescribe an effective medication.

Important! Urine collection for analysis must be performed only before the start of antibiotic therapy, otherwise the microbiological examination will give an incorrect result, and ineffective treatment will lead to the chronicization of pyelonephritis.

Table: OAM parameters for pyelonephritis

Blood test

Usually, for an accurate conclusion, only a urine study is sufficient; it gives more indicative results in pyelonephritis. To clarify the clinical picture of the disease, general and biochemical blood tests are also prescribed. With pyelonephritis, the following change in indicators is characteristic:

  • change in the number of leukocytes upward (more than 9x10 9 / l);
  • increased ESR above 15 mm / h;
  • decrease in erythrocytes beyond the normal range;
  • low hemoglobin levels;
  • a moderate increase in the content of urea and creatinine.

As in the study of urine, in the blood test, an important indicator is the excess of leukocytes, which indicates the current inflammatory process.

For the reliability of the results, it is better to take a blood test on an empty stomach and in the morning.

A general blood test can be taken from a finger; venous blood is taken for a biochemical study. The revealed excess of nitrogenous metabolic products is an indicator of impaired renal function, since during normal operation these substances are quickly and completely removed from the body of a pregnant woman.

Table: the main parameters of the KLA with pyelonephritis

Index Norm Possible deviations
with pyelonephritis
Hemoglobin 120-140 g / l below 120 g / l
Erythrocytes 3,7–4,7*10 12 below 4.7 * 10 12
ESR 2-15 mm / h moderate increase over 15 mm / h
Leukocytes 4–9*10 9 above 9 * 10 9
Gamma Globulin Level 12–22% over 22%
Alpha 2 Globulin Level 7–13% over 13%
Creatinine 53–97 μmol / l over 97 μmol / l

Ultrasound diagnostics

In general, during pregnancy, ultrasound diagnostics of the kidneys is carried out quite often due to the increased load during gestation. If you suspect pyelonephritis in the expectant mother, this study becomes mandatory.

3 days before the ultrasound, you should stop taking products that contribute to increased gas production (cabbage, legumes, black bread, carbonated water and others)

Conducting research

An hour before the ultrasound, it is necessary to drink a large amount of liquid (at least two glasses), since for better reliability, the diagnosis should be carried out with a full bladder.

The procedure is most often performed while sitting or lying on her side; before that, a woman should undress and take off her jewelry to avoid distortion of the data obtained. A gel is applied to the skin of the analyzed area (in the lumbar region), designed to increase the conductivity of ultrasound waves. During the ultrasound, it is forbidden to move, you need to lie or sit still.

The procedure does not take much time. The doctor evaluates the main parameters of both kidneys:

  • location (normally the right kidney is slightly lower than the left);
  • degree of mobility;
  • size (with inflammation of the kidneys increase in size, the norm is considered to be 10-12 cm long, 6 cm wide, 4-5 cm thick. In case of chronic ailments and dystrophy, these organs decrease);
  • the thickness of the renal parenchyma (i.e., tissue). Normally, it is 1.5–2.5 cm, and the tissue itself is homogeneous. Thickening indicates inflammation, thinning is a sign of a chronic form of pyelonephritis;
  • the condition of the renal pelvis - a cavity that stores urine. Normally, it should be free of inclusions (sand, stones);
  • the state of the fibrous capsule - the tissue that is the renal membrane. Should be clearly identifiable during ultrasound and have a flat surface.

Signs of advanced pyelonephritis: a rounded mass with no blood supply, while the rest of the kidney is supplied with blood normally

In acute pyelonephritis, an increase in the size of the kidneys is observed, and the affected organ is enlarged more. On ultrasound, foci of echogenicity with reduced blood flow are visible. With a fairly long chronic disease, there is a decrease in the kidney, as well as a change in the normal blood supply.

The final diagnosis is made by the attending physician. The ultrasound diagnostics doctor only describes the picture that he sees with the help of ultrasonic waves. Making a conclusion only on the basis of ultrasound is not possible.

Magnetic resonance imaging (MRI)

MRI is prescribed by the attending physician for a pregnant woman under certain indications and after an ultrasound scan. The examination is necessary if, during ultrasound diagnostics, purulent-destructive pyelonephritis was suspected, or the clinical picture is seriously changed and causes alertness.

MRI does not pose a threat to the expectant mother, as well as to the baby, provided that his prenatal life reaches 12 weeks, when the main organs of the fetus are already laid.

MRI is a reliable and effective research method that evaluates the work and condition of the renal tissue and urinary tract.

Other research methods

If it is necessary to establish a clearer clinical picture, additional diagnostic methods are used:

  • daily diuresis to determine the dynamics of the disease;
  • daily protein loss;
  • chromocystography to clarify the side of the lesion. It is one of the variants of cystoscopy - a method of examining the organs of the excretory system using a cystoscope. Chromocystography is distinguished by the introduction of intravenous contrast and tracking the course of colored urine through the kidneys;
  • Doppler ultrasound to detect blood flow disorders;
  • catheterization of the ureter for taking OAM from the side of the kidney injury;
  • excretory urography (examination of the kidneys using X-rays), dynamic scintigraphy (a method of radiation diagnostics) - are performed after delivery of a woman to supplement information about the degree of kidney damage obtained during pregnancy.

Video: pregnancy and pyelonephritis - diagnosis and treatment

Differential diagnosis with other diseases

During pregnancy, pyelonephritis is differentiated with the following pathological conditions:

  • exacerbation of gastrointestinal diseases:
    • appendicitis;
    • cholecystitis;
    • ulcers of the stomach and duodenum;
  • diseases of the urinary system:
    • urolithiasis;
    • renal colic;
    • carbuncle of the kidney (purulent-necrotic organ damage);
    • glomerulonephritis (damage to the glomeruli of the kidneys);
  • hypertension;
  • gestosis;
  • infectious diseases:
    • flu;
    • food toxicoinfection.

Table: differential diagnosis of pyelonephritis

Sign Pyelonephritis Gestosis Glomerulonephritis
Anamnesis urinary tract infections: pyelonephritis, cystitis - were before or at the beginning of pregnancy no kidney disease and increased blood pressure before pregnancy had kidney disease before pregnancy
The time of the onset of the disease or its exacerbation
  • before pregnancy;
  • at any stage of pregnancy, but more often in the 2nd trimester.
 in the second half of pregnancy, more often after 22 weeks acute nephritis and exacerbation of chronic nephritis during pregnancy, occur regardless of the duration of pregnancy
Blood pressure can be increased rises usually after 22 weeks more often normal, but may be elevated
Fundus condition retinal artery spasm spasm of retinal arteries with high blood pressure
Edema absent usually available are available in nephrotic and mixed forms
Diuresis normal reduced reduced in nephrotic and mixed forms
Zimnitsky's test (relative density of urine) decreased, less often normal normal normal, less often decreased in case of impaired renal function
Proteinuria (protein in the urine) more often available, but less than 1 g / l more often available more often available
Hematuria (blood in the urine) more often absent absent there is
Cylindruria (casts in urine) more often absent there is gealine and granular cylinders meet
Glomerular filtration more often normal usually less than 60 ml / min usually less than 60 ml / min
Nechiporenko method increased leukocyte count pronounced cylindruria increased number of erythrocytes, pronounced cylindruria
Bacteriuria (bacteria in the urine) more than 10 5 in 1 ml with exacerbation of the process absent absent

Timely detected pyelonephritis does not significantly affect the fetus and the course of pregnancy. When diagnosing inflammation of the kidneys, the disease should not be started; after appropriate tests, the doctor will prescribe drug treatment with drugs that are allowed to be taken during pregnancy. Refusal to treat pyelonephritis is fraught with negative consequences for the mother and child.

For the possibility of carrying a pregnancy, the work of the immune defense is reduced, and this can explain such a wide spread among pregnant women of various acute diseases and exacerbations of chronic ones.

With the formation of acute pyelonephritis during pregnancy, they speak of gestational pyelonephritis, which has completely specific reasons for the formation. Even in the normal course of pregnancy, in the absence of complications, the enlarging uterus will press on all organs of the small pelvis, including the bladder with the ureters.

Depending on the timing of pregnancy, the canal can be pinched - stagnation of urine in it, and return to the kidneys. Such conditions are quite normal for a pregnant woman and are explained physiologically, but sometimes they can cause the infection to enter the kidneys, and stagnation of urine in the ureters will contribute to this. The causative agents of the disease are some cocci, Escherichia coli, rarely yeast-like fungi.

It is possible to distinguish predisposing factors - cystitis, the presence of asymptomatic bacteriuria (bacteria in the urine) even before pregnancy, hypothermia. We must not forget about diabetes mellitus, which arose as a result of pregnancy or existed before.

The aggravating course of the disease includes a violation of the outflow of urine from the kidneys, hereditary predisposition and the presence of other diseases of the genitourinary system.

Symptoms

As a rule, the first symptoms of pyelonephritis appear suddenly. But if pyelonephritis was preceded by asymptomatic bacteriuria or cystitis, the onset of the disease can be erased.

Symptoms of cystitis will be frequent urination, and the urge persists, the portions of urine excreted are small, and the feeling of an incompletely emptied bladder remains. The classic signs of cystitis will be pain during urination - cramps, burning, sometimes you can feel a burning sensation ascending along the ureteral duct.

Symptoms of acute pyelonephritis will be an increase in body temperature, more than 38º, with vivid symptoms of intoxication - chills, increased fatigue, lethargy, headache. Almost at the same time, a painful reaction appears - pain in the lower back, lower abdomen, it can spread to the leg, less often the perineum. You can notice changes in the urine - color, odor, sometimes impurities and sediment.

Diagnostics of the acute pyelonephritis during pregnancy

When the first unpleasant symptoms appear, you should contact a leading obstetrician-gynecologist. The diagnosis and further treatment of pyelonephritis is carried out under the supervision of these specialists. Diagnosing a disease begins with collecting and organizing complaints. The doctor will be interested in when the first symptoms appeared, what preceded them, there were similar episodes in the past, even before pregnancy.

In the future, to confirm the diagnosis, a range of laboratory and instrumental analyzes is assigned:

  • general and biochemical blood test - signs of inflammation are found, and biochemical analysis allows you to evaluate the work of the kidneys;
  • general urine analysis - detection of leukocytes, protein, bacteria;
  • bacteriological analysis - determination of the main pathogen, followed by determination of its resistance to therapy;
  • quantitative urine samples (urine analysis according to Nicheporenko, Zimnitsky), allowing to assess daily urine output and kidney function.

An ultrasound of the kidneys is performed without fail, which shows an increase in the size of the organ, and its individual structures. It is also necessary to assess the condition of the baby in order to exclude the negative impact of the mother's illness on him.

Complications

In the absence of adequate treatment, acute inflammation can cause serious complications. Pyelonephritis can cause premature birth, low birth weight, or distress (breathing problems). Pyelonephritis can cause intrauterine infection of the fetus or the development of kidney failure.

It is worth remembering that this condition significantly increases the likelihood of developing preeclampsia and high blood pressure.

Treatment

What can you do

Treatment of gestational pyelonephritis should always be carried out. If you are afraid of taking antibiotics - completely in vain. The lack of treatment will be much more dangerous, and not only for you, but also for the fetus. Modern antibiotics of the new generation are quite compatible with pregnancy, have a targeted focus and are safe for the fetus, which cannot be said about complications.

You must strictly observe the drinking regime, berry fruit drinks will be useful, but tea and coffee must be discarded. Changes and recommendations apply to food intake, it is necessary to completely exclude spicy, salty, pickled foods. Avoid spicy condiments when cooking. Dishes are best cooked by steaming, stewing, baking or boiling.

The basis of the diet is fresh vegetables, fruits, dairy products; complete protein is also needed. Doctors can recommend adherence to a special therapeutic diet - table number 7, which is characterized as salt-free.

What the doctor does

Almost always, treatment of acute pyelonephritis takes place in a hospital. Antibiotics, uroseptics are selected, it is extremely important to monitor the condition of the fetus and monitor the pressure figures. To maintain the strength of the body, multivitamin complexes, a complex of minerals can be prescribed

Prophylaxis

Disease can be prevented by adhering to a healthy lifestyle and eating right. It is extremely important, even before pregnancy, to treat all infections of the genitourinary system, to identify and treat bacteriuria.

Protect yourself from hypothermia, respiratory infections, stress. Follow your drinking regime, and at the first urge to urinate, immediately go to the toilet. And most importantly, in order to prevent complications, immediately seek help from a specialist, and do not take self-prescribed medications.

Pregnancy is a common cause of inflammation in the genitourinary system. Infectious and inflammatory processes develop in all segments of the urinary system, that is, in the bladder, ureters and kidneys. According to statistics, pyelonephritis of pregnant women ranks first among the diseases of the urinary system. It is triggered by urinary stasis due to fetal growth. The pregnant uterus presses on the kidneys and ureters, thus preventing the flow of urine.

In stagnant urine, microbes, bacteria and fungal flora, even conditionally pathogenic, develop rapidly. Pyelonephritis worsens in the second trimester and can aggravate the further development of the fetus and cause irreparable damage to the mother's health. Therefore, the treatment of pyelonephritis during pregnancy is a serious task for gynecologists and nephrologists in order to save the life of both: the child and the mother.

The hormonal background in pregnant women undergoes transformation from the moment of fertilization of a mature egg. Within 8-13 weeks (second trimester) in the body of a pregnant woman under the influence of progesterone, there are some changes in the parameters of the genitourinary system.

This hormone provokes a decrease in the muscle tone of the ureters and bladder. The growing uterus presses on the kidneys, the fluid of the biological activity of the body stagnates, and as a result, there is a high risk of microbial infection. Most often, the right kidney suffers, this is due to the anatomical feature of the location.

Urinary stasis causes the cups and pelvis to dilate. If the fetus is large or twins are observed, then the pathology can turn into hydronephrosis. In the second trimester, there is a risk of gestational pyelonephritis during pregnancy. Toxicosis can aggravate the pathology and complicate the course of pregnancy.

During this period, there is a risk of miscarriage and stillbirth. After suffering pyelonephritis, patients are born with hypoxia and various infections, as well as with a lowered immune system.

Symptoms of the disease

Symptoms of an infectious and inflammatory process in the kidneys during pregnancy are no different from the symptomatic picture of patients in a normal position. But the symptoms of pyelonephritis during pregnancy can be confused with toxicosis, therefore, diagnostic tests must be carried out to confirm the diagnosis.

The symptomatology of the pathology is as follows:

  • fever and chills (low-grade fever, rises at night);
  • migraine;
  • loss of appetite, nausea, and gag reflex;
  • pain syndrome;
  • localization of back pain or only the zone of the diseased kidney (bilateral pyelonephritis is characterized by bilateral pain, and unilateral pyelonephritis is only one side where the diseased kidney is localized);
  • increased pain during a deep breath, a strong cough, as well as during a night's rest in a certain position (lying on your back, on your side).

Important! The chronic form of kidney inflammation or chronic pyelonephritis during pregnancy manifests itself weakly, and sometimes without any signs, therefore, with the slightest complications, it can lead to irreversible processes up to the death of the mother and the fetus. If symptoms such as headache, lumbar pain, weakness and impaired diuresis are detected, immediately be examined by a nephrologist.

An infectious and inflammatory reaction of the kidneys in pregnant women is very similar in symptoms to signs of miscarriage, so a pregnant woman should be consulted with a gynecologist and nephrologist.

Pyelonephritis manifests itself in different periods of pregnancy in completely different ways:

  • in the early stages, the lower back and lower abdomen hurt;
  • in the second half of pregnancy, the pain intensifies, plus the above symptoms appear.

In some cases, pyelonephritis is detected by random laboratory or instrumental studies. The attending physician will prescribe an individual list of therapeutic drugs under inpatient supervision with regular laboratory tests.

Treatment regimen for gestational pyelonephritis

It is necessary to treat pyelonephritis of pregnant women according to a certain scheme, which consists of several points: body position, herbal medicine and drug treatment.

Choosing the right position

This treatment option relies on relieving the compression of the ureters and freeing the urinary tract to allow urine to flow freely. Sleeping or lying on your back is strictly prohibited. The most optimal position is the left side. The knee-elbow position during pregnancy and if diagnosed with pyelonephritis is a lifesaver.

This pose relieves the ureters, bladder, and kidneys from constant pressure. Urine is excreted unhindered, removing all toxins from the body. You need to be in this position several times a day, up to about 15 times for 15 minutes, during which time the kidneys will have time to work normally and there will be no stasis in them.

Correction of drinking regime

If there are no significant edema and high blood pressure, it is preferable to increase the fluid intake up to 2-3 liters per day. Non-carbonated drinking water, juices, compotes and fruit drinks are recommended.

Strong tea and coffee for pregnant women diagnosed with chronic or acute pyelonephritis are not allowed.

Herbal therapy (herbal medicine)

Herbal infusions or teas have a diuretic effect, but during pregnancy not all herbs are suitable, or rather, there is a list of contraindications, namely: bearberry, yarrow, parsley, licorice, juniper fruits.

The list of acceptable herbal-based products includes: cranberries and lingonberries (fruit drinks from berries), nettle, birch buds.

A decoction of oats has a healing effect. Oats increase the hypertonicity of the ureters, it does not affect the contractile function of the uterus, has an anti-inflammatory effect and improves the functioning of the gastrointestinal tract. As a raw material for cooking, 200 g of cereals are taken per 1 liter of water, cooked over low heat for about 2 hours. Consume 50 ml three times a day before meals.

Of the herbal preparations, you can take Canephron. It contains centaury, lovage and rosemary, making it the perfect combination for treating kidney inflammation during pregnancy.

Drug therapy

In the early stages, it is not recommended to carry out drug therapy, since the placental protection (barrier function) does not work and all drugs enter the embryo, disrupting its formation. Medicines can provoke anomalies in the development of organs and systems. At this time, herbal treatment is recommended for pregnant women.

With poor analyzes with pain, fever and general malaise, you will have to take antibacterial drugs in the form of Amoxicillin or Amoxiclav, otherwise the pathology can give complications up to sepsis and miscarriage.

In the second trimester of pregnancy, antibacterial and antimicrobial agents such as cephalosporins (1st and 3rd generation) are recommended. These include the antibiotics Ceftriaxone or Cefazolin, and Furadonin. After 34-36 weeks are accepted within 7-10 days.

Macrolides (Josamycin, Sumamed, Erythromycin) are widely used without harming the health of the fetus and mother. This group eliminates almost all types of microbial flora. Nitroxoline or 5-NOK - is the most important drug, it is prescribed at 4-5 months of pregnancy in the phase of acute inflammation of the kidneys, cystitis and inflammation of the ureters.

Important! Concerning Gentamicin, Lincomycin, Levomycin, as well as Tetracycline and Biseptol- these drugs are included in the group of prohibited drugs for pyelonephritis in pregnant women.

Infectious and inflammatory pathology of the kidneys and urinary tract of pregnant women occupies the main place among the diseases in this period. It is recommended for all women to be monitored by a nephrologist and be constantly examined to exclude complications during pregnancy, childbirth and the postpartum period.

Video: Pregnancy and kidneys: urine tests during pregnancy

Pyelonephritis is one of the most commonly diagnosed kidney pathologies during pregnancy, which affects up to 12% of women. This is a disease of the urinary tract in which inflammation of the renal pyelocaliceal system develops, caused by a bacterial infection. The development of pathology during the period of bearing a baby is called "gestational pyelonephritis" by doctors. What is the danger of pyelonephritis, what complications of pregnancy can it lead to? How is pyelonephritis treated during pregnancy?

Pyelonephritis is a urological infectious disease. The infection affects the kidneys (calyx, pelvis) and leads to disruption of their work, affecting the urinary system. The risk of developing and developing kidney disease increases precisely in pregnant women, when the kidneys have to work with an increased load. In addition, the hormonal background of a woman carrying a baby changes. The activity of female hormones affects the functioning of the urinary system and kidneys, significantly reduces the tone of the ureter, and blood circulation in the organs is impaired. The longer the gestation period, the more actively the growing uterus presses on the ureter, preventing the outflow of urine from the kidneys, which leads to infection and the development of inflammatory processes in the organs. Sources of infection of the ureter and inflammation of the renal pelvis are pathogenic organisms (chlamydia, streptococci, Escherichia coli, etc.).

Pyelonephritis during pregnancy is caused by the following reasons:

  1. If diseases of pyelonephritis, cystitis, renal failure in a woman have been observed earlier.
  2. Infection of urological organs with pathological microorganisms, which cause inflammation.
  3. Hypothermia, weakening of the immunity of a pregnant woman.
  4. Lack of moderate physical activity, walking in the fresh air, a sedentary lifestyle.

Depending on when the woman first suffered from inflammation, primary and secondary pyelonephritis are isolated. If the disease was first diagnosed during pregnancy, this is the primary form of pyelonephritis. With secondary pyelonephritis, an exacerbation of the disease occurs, diagnosed before conception.

From the form in which the disease proceeds, doctors diagnose:

  • Chronic form of pyelonephritis. The peculiarity of the course of this form of the disease during pregnancy is latent symptoms that may not appear or make themselves felt periodically. Only through laboratory and bacteriological studies of urine can the presence of an infection in the kidneys be established. This variant of the disease is observed in expectant mothers who previously suffered from pyelonephritis, and an exacerbation occurred during pregnancy.
  • Acute pyelonephritis is manifested by sharp and sudden symptoms of the disease after infection. The disease develops in less than a day. Timely treatment promotes rapid recovery without complications.

Pyelonephritis during pregnancy: symptoms

The main symptoms and the first signs of the disease appear from the 2nd trimester (22-24 weeks of pregnancy), depending on the form of the disease.

  • The acute form of pyelonephritis, as a rule, is accompanied by a high temperature up to 38-40 degrees and chills. A pregnant woman feels a sharp pulling or sharp pain in the lumbar region, sometimes from only one affected side. Painful sensations and shooting pains from the lower back spread to the abdomen and perineum. The pain can be quite severe, it is difficult for a woman to get out of bed. There is a violation in the process of urination: the urine changes color, becomes cloudy, acquires a pungent odor, and a sharp pain is felt when urinating. In addition to painful sensations, the pregnant woman feels body aches, lethargy, weakness, nausea.
  • Chronic pyelonephritis during pregnancy is not so bright, manifests itself in tolerable lower back pain, which is aching and dull in nature. The pregnant woman feels weak, drowsy, gets tired quickly. Sometimes the patient may not attach importance to pain, considering it the norm during pregnancy. The pain may increase gradually, over time, the color and smell of urine changes.

Pyelonephritis in early pregnancy - features of the course

Kidney disease that occurs in the 1st trimester (up to 12 weeks) is especially difficult and painful. The pain is intense and resembles acute renal colic. A woman cannot relax, she is forced to take the only position that is convenient for her at the moment, which dulls the pain a little and curls up. The inflammatory process is very dangerous for the course of pregnancy and can lead to its termination.

In addition, there is a possibility of infection of the fetus and disruption of its normal development. Treatment of kidney inflammation is complicated by the fact that many drugs, including antibiotics, are not given to pregnant women. The main task of doctors is to find the safest and most effective way to solve this problem in order to minimize the likelihood of complications and consequences after treatment.

Consequences of pyelonephritis during pregnancy

Expectant mothers who have had to deal with kidney inflammation are worried about the consequences and complications after the illness. Possible complications of pregnancy include:

  • Exacerbation of chronic pyelonephritis in late pregnancy (up to 30 weeks) can cause premature birth.
  • Kidney pathology in the 1st trimester threatens spontaneous miscarriage.
  • Anemia is a frequent companion of a pregnant woman after suffering pyelonephritis, dangerous complications - to forced oxygen starvation of the fetus.
  • Infectious toxic shock.
  • The emergence of acute renal failure, purulent inflammation in the kidney.
  • Polyhydramnios.
  • Gestosis in pregnant women is one of the most dangerous complications, manifested by an increase in blood pressure, which leads to vasospasm, edema, and fetal hypoxia.

What is the danger of pyelonephritis during pregnancy for the fetus

The consequences of the postponed pyelonephritis for the unborn baby are no less terrible. Intoxication, which accompanies the disease, has a negative effect on the condition of the fetus, causes a violation of the blood supply, which leads to fetal hypoxia. As a rule, after a disease suffered during pregnancy, a newborn is born with a low weight, and developmental delay is often diagnosed. Microorganisms that cause kidney inflammation can infect the fetus in the womb and lead to fetal malformations or death.

To avoid all the terrible consequences of an insidious disease, it is necessary to consult a doctor in time at the first symptoms and start the treatment prescribed by the doctor as soon as possible.

Pyelonephritis in women during pregnancy - diagnosis

To diagnose kidney pyelonephritis during pregnancy, a number of laboratory tests are carried out, on the basis of which the doctor prescribes appropriate treatment:

  1. General and biochemical blood test - the level of leukocytes in pyelonephritis increases significantly, and hemoglobin falls.
  2. Urine analysis according to Nechiporenko - shows the level of immune cells of leukocytes in the urine. Their increased content is a clear sign of an inflammatory process.
  3. General analysis of urine - taken in order to identify protein and leukocytes in the urine.
  4. Bacterial urine test - is taken to accurately determine the causative agent of the disease, and its sensitivity to a certain group of antibiotics is also established.
  5. Ultrasound of the kidneys - as a rule, an ultrasound examination shows an increase in the organ, a change in its structure.

After the necessary research, the doctor prescribes treatment for the patient.

Pyelonephritis during pregnancy: treatment

Pyelonephritis is a dangerous complication and consequences of the disease that requires treatment in a hospital under the supervision of qualified doctors. At the first, even minor suspicions of kidney inflammation, a pregnant woman should consult a doctor. Only a doctor, after examining and testing, will prescribe treatment and select drugs that are safe for the fetus. While in the hospital, bed rest is mandatory. Exercise is contraindicated for pregnant women; absolute rest is recommended. When treating a patient in the first trimester of pregnancy, if pyelonephritis is mild, doctors can prescribe non-drug treatment, which is as follows:

  1. Compliance with a diet. The diet of the expectant mother should be rich in fruits and vegetables, fermented milk products are useful. The use of vinegar, spices, onions and garlic, spicy and pickled foods is excluded. It is necessary to temporarily limit the use of strong tea, coffee and quit smoking. To avoid edema, it is advisable to reduce your salt intake.
  2. Compliance with the drinking regime. A woman suffering from pyelonephritis should drink at least 3 liters of fluid per day. In addition to water, you can drink berry juices (cranberry, currant, lingonberry), compotes.
  3. For a better outflow of urine from an infected kidney, a pregnant woman needs to sleep on her side; it is not recommended to sleep on her back. Doctors advise taking the knee-elbow position and staying in it for up to 15 minutes several times a day.

If the course of the disease causes severe pain and proceeds with complications, doctors prescribe antibiotic treatment, the choice of which depends on the duration of pregnancy and the severity of the disease.

For the treatment of pyelonephritis during pregnancy, antibiotic treatment is used:

  • Ampicillin;
  • Cephalosporins;
  • Oxacillin;
  • Gentamicin.

In addition to antibiotics, the doctor prescribes antispasmodics and, if necessary, pain relievers. Many pregnant women become anxious and panic when they learn that the doctor has decided to use antibiotics for treatment. Expectant mothers should understand that the absence of antibiotic treatment, especially in a severe form of the disease, is much more dangerous for the fetus and poses a threat to the health and life of the baby. There are antibiotics that are allowed in the early stages, and starting from the second half of pregnancy, the sensitivity of the fetus to certain groups of antibiotics decreases and their intake is safe for the baby.

Folk remedies for pyelonephritis during pregnancy

Non-traditional methods of treating any disease during pregnancy should be treated with extreme caution. Pharmacies offer a wide range of medicinal herbs and herbal preparations, the action of which is aimed at "flushing" the infection from the kidneys and relieving inflammation. These are kidney fees, bearberry, marsh calamus, etc. Herbs are brewed with boiling water, filtered. Take 1 glass of broth three times a day before meals, a course of 2 months. Before taking renal charges, you should consult with your doctor.

In addition to medicinal decoctions, you can cook compotes or fruit drinks from cranberries, lingonberries, sea buckthorn, which have an excellent diuretic effect, as well as brew rose hips. Healthy drinks can be drunk throughout pregnancy.

The most effective recipes for pyelonephritis

  • A decoction of corn silk.
    Pour 1 tbsp of corn silk with 1 glass of water and cook for 20 minutes. Insist the broth for half an hour, and then strain. Take a tincture of 2 tablespoons every three hours.
  • Yarrow tincture.
    Pour 2 teaspoons of the herb with a glass of water and leave for 1 hour, drain. Take 3 tablespoons 5 times a day.

Prevention of pyelonephritis during pregnancy

As you know, the best way to treat an ailment is to prevent it. To avoid infection and prevent kidney inflammation, a pregnant woman must adhere to the following rules:

  1. Engage in moderate physical activity, daily walks in the fresh air are beneficial. By doing special exercises for pregnant women, you can strengthen your back muscles to improve the tone of your internal organs.
  2. If a pregnant woman suffered from cystitis or pyelonephritis before conception, then from the first weeks of pregnancy it is important for her to follow a diet and a drinking regime for a better outflow of urine from the kidneys.
  3. Empty the bladder at least every 3-4 hours, preventing harmful microorganisms from multiplying.
  4. When planning a pregnancy, it is imperative to undergo a kidney examination for chronic pyelonephritis and treat existing diseases of the genitourinary system.
  5. Pregnant women should not hypothermia, chill legs and back, dress not for the weather.
  6. Drink at least 1.5 liters of liquid per day, including vitamin juices, compotes.

An attentive and careful attitude towards yourself and your health, adherence to preventive measures will help prevent the development of a dangerous kidney disease. If you have not been able to avoid infection, have found symptoms of pyelonephritis, urgently seek medical help in order to start treatment without delay.

Gestational pyelonephritis is a fairly common kidney disease that develops during pregnancy. As a rule, women who decide to become mothers for the first time suffer from the disease: the body is under stress and is most susceptible to infections.

Pyelonephritis not only creates physiological inconveniences. The progression of the disease during pregnancy leads to a number of serious complications, up to and including miscarriage.

Timely diagnostics and a set of medical measures prescribed by a doctor will help to avoid problems.

Pyelonephritis: characteristics and types of disease

Pyelonephritis belongs to the category of infectious diseases. The causative agents are pathogenic microorganisms (more often enterobacteria and various cocci). Penetrating through the blood and ureters into the kidneys, bacteria cause inflammatory foci in the interstitial tissues, pelvis, calyces.

important If treatment is not started on time, new parenchyma will be constantly involved in the process with the formation of scars at the site of dead areas. This can eventually lead to kidney failure.

Two types of pyelonephritis are diagnosed:

  • acute, in which a purulent inflammatory process develops in the renal pelvis and calyces. It occurs, as a rule, in one kidney, during pregnancy - in the right one;
  • chronic, resulting from insufficient therapy of an acute illness. Sometimes it occurs as a complication of other inflammatory processes (for example, cystitis) or gynecological problems. More often it is two-sided.

Causes of the disease in pregnant women

The direct cause of the disease is microbes entering the tissues. Doctors attribute pregnancy to one of the main risk factors for the development of pyelonephritis. This is due to a number of interrelated circumstances.

  • Physiological features. The woman's uterus increases in size, compresses the urinary tract, which makes it difficult for the outflow of biological fluid. The pressure builds up in a crowded bladder. A phenomenon known as vesicoureteral reflux occurs: the reflux of urine back into the ureter.
  • Change in hormonal levels. The progesterone produced by the placenta relaxes the smooth muscles of the bladder, provokes ureteral hypotonia, stretching of the renal pelvis. The body's protective functions are weakened.
  • Purulent and infectious diseases (furunculosis, chronic tonsillitis) reduce the immunity of an already weakened organism. The lack of protective mechanisms contributes to the easy penetration of bacterial microflora.

Stagnant liquid is an ideal breeding ground for bacteria.

Symptoms of the disease

One of the main symptoms of pyelonephritis is pain in the lumbar region. Often, expectant mothers do not focus on them, attributing unpleasant sensations to the increased load on the spine.

important Pain during pregnancy usually occurs on the right side and is local in nature.

You can not postpone a visit to the doctor with the following symptoms:

  • increased body temperature, chills;
  • difficulty urinating, often accompanied by sharp pains;
  • cloudy urine, sometimes with purulent discharge;
  • disruption of the digestive system;
  • pain in the kidney area is worse with movement or tapping.

important A chronic disease can be asymptomatic, manifesting itself only with aching lumbar pains. Sometimes there is an increase in temperature in the morning and evening hours.

Diagnostics of the pyelonephritis

The symptoms of pyelonephritis are similar to those of other inflammatory and infectious diseases. Research will help to make a correct diagnosis:

  • : shows a structural change in the kidneys; the method is safe for the fetus (unlike);
  • : general, according to Nechiporenko, Zimnitsky's test - the most reliable diagnostic methods. They help to identify an asymptomatic disease by the presence of bacteria, proteins, leukocytes in the urine, to assess the functional state of the kidneys, the effectiveness of the therapy;
  • a biochemical blood test is important for detecting high levels of urea and residual nitrogen - symptoms of kidney inflammation.

Diagnosis of pyelonephritis is carried out in stationary conditions.

Why is pyelonephritis dangerous during pregnancy?

The danger of pyelonephritis for the expectant mother and fetus is assessed by the degree of risk:

  • I degree is characterized by acute uncomplicated inflammation; easy to treat; with timely therapy, the disease does not pose a threat, but in a neglected state, infection of the fetus is possible;
  • Grade II usually occurs with exacerbation of chronic pyelonephritis, present in the history of the expectant mother. It is characterized by frequent complications. With timely therapy, the prognosis is favorable;
  • III degree of the disease poses a serious threat to the life of a pregnant woman. This is usually associated with the development of severe renal failure, late toxicosis. This also includes pyelonephritis of the only kidney. Pregnancy in this case is contraindicated.

important Pyelonephritis can provoke intrauterine infection of the fetus, cause premature birth. In a severe case, cause spontaneous termination of pregnancy at any time.

Exacerbation of pyelonephritis during pregnancy

An exacerbation of the disease during pregnancy is more often observed in chronic secondary pyelonephritis, which is accompanied by other inflammatory processes in the genitourinary system or arises as a complication after an infection.

Acute pyelonephritis usually appears at 20-30 weeks. May be caused by obstruction of the urinary tract.

An exacerbation of pyelonephritis is often the cause. The condition is difficult to treat. It causes complications in the form of dysfunction of the placenta, the development of intrauterine fetal pathology.

Treatment of pyelonephritis in early and late pregnancy

Pyelonephritis refers to diseases that require immediate treatment. The event is aimed at destroying pathogenic microorganisms that cause the inflammatory process. Antibiotics can solve the problem. The complexity of treatment is due to the need to take into account the effect of antibacterial agents on the fetus. Most drugs pose a threat to the unborn child.

Treatment methods depend on the form of pyelonephritis and the duration of pregnancy:

  • semi-synthetic antibiotics of the penicillin group (ampicillin, amoxicillin) are considered safe enough, but they are not highly effective. Prescribed in the first trimester, when the fetus is especially vulnerable. Used to treat mild inflammation;
  • antibiotics of the macrolide group (erythromycin) or cephalosporin (cephalexin, ceftazidime) can be taken from the second trimester. Prescribed for the treatment of a chronic disease in the acute stage strictly under laboratory control of biochemical parameters;
  • antispasmodic drugs not only relieve pain, but also relieve inflammation. In the first trimester, you can take no-shpa, paracetamol: the drugs penetrate the placenta, but are safe for the fetus. From the second trimester, spazmalgon, baralgin are prescribed;
  • a special set of exercises allows you to reduce the pressure on the ureters, restore the movement of urine;
  • prescribed from the first trimester to restore immunity;
  • phytotherapy is used from the first trimester in parallel with antibiotics as an adjunct. Special pharmaceutical herbal remedies have proven themselves well: phytolysin and others.

important Sulfonamides, tetracyclines, aminoglycosides are fatal to the fetus. Taking these drugs is prohibited at any stage of pregnancy.

Prevention of pyelonephritis

To reduce the likelihood of developing pyelonephritis will help a woman's adherence to personal hygiene, giving up bad habits, and proper nutrition. It is necessary to eliminate infectious foci (for example, caries).

If the expectant mother has a history of chronic pyelonephritis or cystitis, the doctor, in addition to special observation, may prescribe:

  • plant antiseptics (kanephron N);
  • drugs to stimulate immunity (cordyceps);
  • herbal medicine;
  • lab tests.

Pyelonephritis after childbirth

An exacerbation of pyelonephritis can occur in the postpartum period. The disease is characterized by fever, painful urination.

Based on the results of blood and urine tests, antibiotics and fluid therapy are prescribed.

important When taking antibiotics, breastfeeding is prohibited.