Chronic pyelonephritis in pregnant women treatment. Causes and mechanism of development of the disease. What disorders can occur in the fetus

19.06.2019

In the process of carrying a child, the female body is especially fragile and prone to various pathologies. Often there is inflammation of the kidneys during pregnancy, in medicine, the disease is called nephritis. It is characterized by an infectious lesion of the urinary system and kidneys. During pregnancy, a woman's immunity weakens, which allows infections to easily enter the body. This disease causes discomfort, painful sensations and problems with urination. Without treatment, the pathology will harm the health of the woman and the fetus.

Causes of kidney inflammation during pregnancy

Inflammation of the kidneys during pregnancy is a rather common problem, since in the process of gestation, this organ weakens and easily becomes infected. In this case, pressure is exerted on the kidneys from the growing uterus, the ureter is squeezed and it becomes difficult to excrete urine. Pathology occurs due to the expansion of the renal pelvis, which allows harmful bacteria to enter the organ. Other causes of pathology include:

congenital or acquired renal diseases that were present before pregnancy;
chronic diseases (kidney stones, diabetes mellitus and others);
chronic cystitis;
increased load on the woman's body in position;
hormonal disruption due to the formation and development of the fetus;
reduced immunity.

Pathogenesis

There is also the fact that in the process of carrying a child, a woman may have an outflow of urine in the reverse order: from the bladder to the kidneys. If the urine contains bacteria, then they remain on the renal tissue in the pelvis, where active reproduction takes place. If, during the next general analysis of urine, bacteria are found in the fluid, then doctors diagnose nephritis, which needs treatment. Doctors recommend that pregnant women dress warmly during the cold period so that hypothermia of the internal organ does not occur. It is advised to stop consuming spicy foods and avoid strenuous physical activity.

Symptoms

In most cases, inflammatory processes in the kidneys in pregnant women are asymptomatic, so they are detected late. It is important to regularly take blood and urine tests so as not to miss the first "bells" that signal the development of pathology. Since during pregnancy significant pressure is exerted on the kidneys by the growing uterus, it is not always possible to notice the development of inflammation. Nephritis during pregnancy can be identified by the following symptoms:

high body temperature;
painful sensations in the head;
rapid pulse and shortness of breath;
nausea, in rare cases, vomiting;
weakness, fatigue;
back pain that gets worse at night while walking
pain with tension of the abdominal muscles.

It is important to see a doctor on time.

It is important to pay attention to the above symptoms in time and, when they are first detected, consult a doctor. Inflammation of the kidneys during pregnancy in an advanced form will lead to early childbirth or involuntary miscarriage. The weakening of symptoms and their indistinct manifestation or abrupt disappearance indicates chronic nephritis during pregnancy.

In the chronic form, complications arise that negatively affect the development of the fetus. It is important to determine the cause of nephritis in a timely manner and influence not only the symptoms, but also the focus of the disease, so that a relapse does not occur later. Given the symptoms that are present in a pregnant woman, and the causes of the pathology, the doctor prescribes individual treatment.

Diagnostics

During pregnancy, regular monitoring of the condition of the kidneys and urinary system is carried out through the delivery of urine and blood tests. This should be given due attention, since early detection of inflammation can avoid complications and save the developing fetus. To determine the concentration ability of an internal organ, a Zimnitsky test is carried out. The procedure consists in the daily collection of urine (at least 8 times), then the density of each analysis is measured. In case of deviations from the norm, doctors diagnose nephritis.

Additionally, pathology can be detected using ultrasound diagnostics, which is carried out in each trimester or more often, if indicated. But the most reliable and accurate are laboratory results of the study of urine and blood. In accordance with the test results and the general condition of the pregnant woman, the doctor prescribes proper treatment. In most cases, a woman is offered therapy in an inpatient setting.

The vital activity of a pregnant woman's body is aimed at creating and ensuring optimal conditions for the development of the fetus. During pregnancy, the restructuring of the activity of a woman's body affects almost all organs and systems, from the central nervous system to the musculoskeletal system. In particular, specific changes in kidney function occur in pregnant women, which, together with other pathological factors, can lead to the development of one or another kidney disease.

One of the most common kidney diseases in pregnant women is pyelonephritis .

MM Shekhtman in his 1987 monograph states that this disease occurs in 12.2% of pregnant women.

Pyelonephritis- a disease characterized by damage to the interstitial tissue of the kidney, with the involvement of the renal pelvis and calyces in the process. The development of pyelonephritis is due to the presence of an infectious focus in the body (inflammatory diseases in the genitals and organs of the urinary system, carious teeth, boils, etc.) and a violation of urodynamics (urine duct) of the upper urinary tract of a pregnant woman.

This process can be observed during pregnancy, childbirth and after childbirth, i.e. at all stages of the gestational period, it is advisable to use the term "gestational pyelonephritis".

Symptoms of gestational pyelonephritis

Clinically gestational pyelonephritis proceeds in an acute or chronic form.

For acute purulent gestational pyelonephritis in pregnant women, the following symptoms are characteristic:

tremendous chills with high fever, severe headache, muscle aches;
nausea, sometimes vomiting;
increased breathing and heart rate;
sweating and the subsequent decrease in temperature down to normal numbers.

Lethargy, weakness are noted between the chills. Disturbed by severe soreness in the lumbar region, corresponding to the side of the lesion, radiating to the upper abdomen, groin, perineum, thigh. Increased pain is characteristic at night, in the position of the patient on the back or on the side opposite to the diseased kidney, as well as when coughing, taking a deep breath.

On bimanual palpation, there is soreness and tension in the abdominal muscles.

The most important point is differentiation pyelonephritis in the patient, in the form of the process: destructive (purulent fusion of the renal tissue) and non-destructive, on which the patient's treatment tactics depend.

Chronic gestational pyelonephritis dull pains in the lumbar region are inherent, aggravated by movement and physical exertion, headache, general weakness and fatigue.

There is an asymptomatic course.

Causes of gestational pyelonephritis

To pathogens of gestational pyelonephritis include microorganisms of the enterobacteriaceae group (Escherichia coli, Klebsiella, Proteus) and Enterococcus. The predominance of Escherichia coli and Proteus among the causative agents of gestational pyelonephritis is associated with the anatomical proximity and common circulation of the urinary system, intestines and genitals. However, not all pregnant women develop this disease; the disease develops in cases where the patient has a decrease in the immune status. It is necessary to say about the possibility of the development of gestational pyelonephritis under the influence of L-forms of microorganisms (bacteria that have lost their cell wall under the influence of antibiotics, changes in the acidity of urine). Such microorganisms are more resistant to external influences, and when favorable conditions arise, they transform again and the corresponding vegetative forms, which cause the development of the disease.

Microorganisms enter the kidney through the blood, lymph from the focus of inflammation or ascending from the lower parts of the ureter, urethra, vagina.

The second factor in the development of gestational pyelonephritis in pregnant women is a violation of the urodynamics of the urogenital tract, which may be associated not only with mechanical reasons, but also, according to the results of recent studies, with the effect of female sex hormones (estrogens, progesterone, etc.). It is noted that the highest level of hormones is observed in the second half of pregnancy, at the same time the development of gestational pyelonephritis in pregnant women is characteristic. The effect of an increased hormonal background is directed to the renal calyx system, ureters and bladder, which leads to impaired urine outflow and reverse urine reflux and, as a consequence, to its stagnation in the pelvis-calyx system, the reproduction of pathological microorganisms and the development of gestational pyelonephritis.

For the development of gestational pyelonephritis the most important is a decrease in immunity or an immunological imbalance. In pregnant women, there is a decrease in immunity, which makes it possible to carry a fetus that is genetically foreign to the woman's body, a predisposing factor for the development of gestational pyelonephritis is a decrease in the amount of IgG in the second trimester of pregnancy, which significantly reduces the ability of a pregnant woman's body in the fight against pathological microorganisms.

Complications of pyelonephritis during pregnancy

Analyzing the course of pregnancy and childbirth in women suffering pyelonephritis, it should be noted that acute gestational pyelonephritis, which first appeared during pregnancy, has a less pronounced adverse effect on the course of pregnancy.

With a long course of chronic pyelonephritis miscarriage is often observed, termination is most often observed at 16-24 weeks (6% of women), more often in such women and premature birth (25% of women). The main reason leading to the termination of pregnancy is severe forms of gestosis, which often develop in chronic pyelonephritis.

Currently acute gestational pyelonephritis does not serve as an indication for termination of pregnancy if there are no other obstetric indications. Some authors argue that termination of pregnancy against the background of an active process can aggravate the course of the inflammatory process up to the development of sepsis and septic uterine bleeding.

Acute gestational pyelonephritis, which arose during pregnancy, despite the acute course at the onset of the disease, with timely treatment, does not lead to the development of complications, which cannot be said about the course of chronic pyelonephritis. This disease, even if it does not worsen during pregnancy, is more often complicated by nephropathy, premature birth or severe preeclampsia, which is an indication for termination of pregnancy. The methods used to terminate a pregnancy are different and depend on the duration of the pregnancy and the severity of the patient's condition.

In a full-term pregnancy, a woman with a gestational pyelonephritis can give birth on their own, with the full use of pain relievers. In the postpartum period, it is advisable to carry out a course of antibiotic treatment.

It should be noted that children born to women who have undergone an acute or chronic form of the disease often have signs of intrauterine infection, some die in the early postpartum period. Based on all of the above, it follows that pregnant women with acute or chronic gestational pyelonephritis need special supervision and timely treatment.

Of great importance during pregnancy and the normal development of the fetus is the presence or absence of hypertension, as well as azotemia during chronic pyelonephritis... Depending on this, three degrees of risk are distinguished in pregnant women:

I degree of risk - uncomplicated pyelonephritis that occurs during pregnancy;
II degree of risk - chronic pyelonephritis, which arose even before pregnancy;
III degree of risk - chronic pyelonephritis with hypertension or azotemia, pyelonephritis of a single kidney.

Diagnosis of pyelonephritis during pregnancy

To establish a diagnosis, in addition to clinical and objective data, it is necessary to carry out a full range of laboratory tests (blood, urine, discharge from the genitals) and instrumental examinations, but this is not always possible to perform in a pregnant patient. In particular, X-ray research methods cannot be applied. Therefore, clinical observation, laboratory, ultrasound and endoscopic studies are leading in the diagnosis of gestational pyelonephritis in pregnant women.

In a laboratory study of blood in 16% of women with chronic gestational pyelonephritis, hypochromic anemia is noted. In urine tests, there is moderate proteinuria (less than 1 g / l.), Leukocyturia and microhematuria (the presence of leukocytes and erythrocytes in the urine). In the study of urine according to the Zimnitsky method, with this disease, hypostenuria is noted (a small amount of protein up to 1 g / l.).

Often during chronic gestational pyelonephritis in pregnant women, it is noted hypertension... Hypertension with this disease is high, has a progressive course and in 15-20% of cases becomes malignant. Such patients are shown early termination of pregnancy.

The course of chronic pyelonephritis is long-term, ultimately leading to the wrinkling of the kidney, characterized by severe hypertension and chronic renal failure.

In the blood of pregnant women with acute gestational pyelonephritis there is a pronounced increase in leukocytes, a neutrophilic shift of the leukocyte formula to the left due to an increase in stab forms and hypochromic anemia, possibly an increase in the level of blood serum urea.

In order to obtain reliable data when examining the composition of urine, it is important to explain to a pregnant woman the rules for collecting urine. It is necessary to obtain an average portion of urine after a thorough toilet of the external genital organs or to catheterize the bladder if it is impossible to collect urine on your own. If there is a detection of pathological elements in the analysis, it is necessary to repeat it in two portions - the first and the second (sample of two glasses). If an increased number of leukocytes is determined only in the first portion of urine, this indicates the localization of inflammation in the urethra or genitals, and if there is an increase in leukocytes in both portions, this suggests the presence of an inflammatory process in the bladder or in the upper urinary tract.

For a more detailed study of the localization of the inflammatory process in these cases, a separate collection of urine from the kidneys by a ureteral catheter is required. The most preferred study in pregnant women is the Nechiporenko test, where the number of leukocytes and erythrocytes is determined. Necessary and informative is a bacteriological study of urine, which shows both the quantitative determination of bacteria (infectious agents) and their sensitivity to antibiotics. However, it should be noted that asymptomatic bacteriuria occurs during pregnancy in 2.5-11% of women and only in 20-40% of them it leads to the development of pyelonephritis.

To determine the degree of violation of the passage of urine from the upper urinary tract in pregnant women, chromocystoscopy is used, which consists in observing the release of a contrast agent. Disorders of urine excretion can occur in a woman's body even before pregnancy, but they were compensated for and did not lead to prolonged stagnation of urine and, as a consequence, to the development of gestational pyelonephritis, while due to an increase in the load on the kidneys during pregnancy, compensatory mechanisms cannot cope, and the disease occurs.

Ureteral catheterization in the presence of clinical signs of gestational pyelonephritis it is necessary both for diagnostic purposes and to restore the impaired outflow of urine from the upper urinary tract. To all of the above, we can add that gestational pyelonephritis in the second half of pregnancy is usually bilateral, and the study of urine collected in this way helps to diagnose this.

Ultrasound examination of the kidneys is also of great value for diagnostics, by means of which an increase in the size of the kidneys and changes in their structure during inflammation are determined. Subsequently, after childbirth, it is possible to examine kidney function using excretory urography (for this, a contrast agent is injected into the vein, which is visible on an X-ray, and pictures are taken). This type of study is the most informative in chronic pyelonephritis, since ultrasound is not informative enough.

Treatment of pyelonephritis during pregnancy

Treatment of gestational pyelonephritis in pregnant women women must be carried out in a hospital setting, since the development of severe complications that threaten the life of the mother and child is possible.

Such patients are recommended to rest in bed for the duration of acute manifestations (4-6 days), and in the future (to improve the passage of urine), it is necessary to take a knee-elbow position 2-3 times a day for up to 5 minutes, a position in bed on the opposite side of the patient is also recommended kidney side. It is necessary to follow a diet that facilitates the work of the intestines: beets, prunes, fortified broths of rose hips, cranberries, black currants are useful; restriction of fluid is shown only with a bilateral process in the kidneys or the addition of preeclampsia. If edema occurs, you should abandon the abundant administration of fluid.

It is important to eliminate urodynamic disorders of the urine duct of the superficial urinary tract, which can be done through the following measures:

catheterization of the ureters (removed after 3-4 days);
internal drainage of the upper urinary tract with a self-retaining stent catheter;
percutaneous puncture nephrostomy;
open surgery (decapsulation of the kidney, sanitation of foci of purulent destruction with nephrostomy).

The choice of one of the above methods depends on the duration of the attack of pyelonephritis, the recurrence of attacks, the severity of intoxication, the degree of expansion of the renal pyelocaliceal system, the duration of pregnancy, the nature of the microflora, etc.

When treating pregnant women, it is necessary to take into account not only the effectiveness of the drug, but also its safety for the fetus. This task is complicated by the fact that antibacterial drugs are used to treat gestational pyelonephritis, which can have a toxic effect on the development of the fetus. In addition to all of the above, under the influence of pathological microorganisms, the barrier function of the placenta is disrupted and its permeability to many medicinal substances increases, in addition, some antibiotics can affect the tone of the uterus, for example, ampicillin aggravates the threat of termination of pregnancy, while lincomycin promotes muscle relaxation (decreased tone), which promotes prolongation of pregnancy. Therefore, when prescribing therapy, one should take into account the duration of pregnancy and the data on the total functional ability of the kidneys (i.e., it is necessary to monitor the density of urine and the amount of creatinine), the individual tolerance of the drug.

The recommended duration of treatment is at least 4-6 weeks, frequent change of antibacterial agents (every 10-14 days), taking into account the sensitivity of the urine microflora. Prescribing the drug without taking into account sensitivity, immediately after taking urine for sowing, is possible only in severe conditions.

Treatment in the first trimester of pregnancy can be carried out with natural and semi-synthetic penicillins, other drugs adversely affect the fetus during its embryo and organogenesis. With a mild course, ampicillin is prescribed orally 2-4 million units per day for a course of 8-10 days; for the treatment of more severe forms, you can use securopen (azlocillin) 1-2 g 3-4 times a day intramuscularly (for acute processes in the kidneys up to 5 g intravenously); the course of treatment does not exceed 6-10 days.

In the second and third trimesters of pregnancy, antibiotics and drugs are used more widely, since the formation of fetal organs and systems by this period ends, and the formed placenta provides a barrier function to some antibacterial and antimicrobial drugs. Therefore, in addition to natural and semi-synthetic penicillins, it is possible to use broad-spectrum antibiotics from the cephalosporin group. In total, four generations of cephalosporins have been released, the most appropriate is the use of third-generation cephalosporins: cefixime (suprex), cefsan at a dose of 400 mg. (1 tablet) once for the treatment of gestational pyelonephritis caused by bacterial flora (Pseudomonas aeruginosa, aerobic and anaerobic microorganisms). It is also possible to prescribe antibiotics of the aminoglycoside group, which act against many gram-positive and gram-negative microbes.

Of the three generations of aminoglycosides, it is most advisable to use third-generation drugs, for example, netilmecin according to a specific scheme, selected individually, the duration of the course is 7-10 days, depending on the severity of the disease. The only thing to remember about the ototoxicity of aminoglysides, but this is with their long-term use. If, during urine culture, coccal flora (streptococci, staphylococci) is determined, a group of macrolides (erythromycin 1-3 g per day) or a group of lincosamines (lincomycin 1.5-2 g per day and clindomycin 0.6-1.8 per day) with a course of 7-14 days. But there are antibacterial drugs that are categorically contraindicated during pregnancy, for example, antibiotics of the tetracycline, chloramphenicol, streptomycin series.

It should be noted that in severe disease it is possible to combine antibacterial drugs, in particular the group of cephalosporins with aminoglycazides and metronidazole (or lincomycin) for 3-4 days. The indications for the appointment of combination therapy are severe course with an unknown pathogen or variability in antibiotic sensitivity. According to the spectrum of antibacterial activity, the group of antibacterial drugs carbopinem approaches this combination, for example, thienes are prescribed 250-1000 mg every 6-12 hours.

In the tactics of treating gestational pyelonephritis, there is the use of drugs that act directly on microorganisms - 5-NOK, nevigramon, furagin, urosulfan. They are used both alone and in combination with antibiotics. The choice of drug depends on the causative agent of the disease obtained by urine culture. So, in particular, 5-NOK selectively acts on gram-positive and gram-negative flora of the urinary tract, nevigramone has a high chemotherapeutic effect on the growth of Escherichia coli, Proteus, Klebsiella. Furagin has an effect on gram-positive and gram-negative microorganisms that are resistant to antibiotics and sulfonamides. Of the sulfonamides in the treatment of gestational pyelonephritis, the following drugs are used: urosulfan, etazole, which are most active in staphylococcal and colibacillary infections.

Despite the fact that the drugs are low-toxic, it is better to cancel them 10-14 days before the due date, as they can cause kernicterus in the newborn. You can prescribe antibiotics of the fluoroquinolone series if the causative agent is gram-positive microbes (almost all enterobacteria, Pseudomonas aeruginosa) and gram-positive microorganisms, aerobes and anaerobes, intracellular microorganisms, including mycoplasma and chlamydia. The main thing in the selection of therapy is a strictly individual selection of drugs, taking into account the sensitivity of microorganisms to antibiotics and the individual tolerance of the selected treatment.

To relieve the intoxication syndrome, it is necessary to hospitalize the pregnant woman in the department and take all the necessary detoxification measures.

For desensitizing therapy, you can use 0.05 g of diazolin, one tablet 2-3 times a day, 0.05 g of diphenhydramine, 0.025 g of suprastin. Antispasmodics are used to improve the flow of urine, for this purpose it is possible to use: baralgin 5 ml intramuscularly, 2 ml no-shpa intramuscularly, 2 ml of a 2% solution of papaverine intramuscularly. In order to modulate the immune response in gestational pyelonephritis, levamisole 150 mg is used. 3 times a week, and to increase the activity of nonspecific protective factors of leukocytes, methyluracil is prescribed 0.5 g 4 times a day, pentoxil 0.2 g 3 times a day, vitamin C.

If there is long-term antibiotic treatment, it is necessary to use antifungal drugs, for example, nystatin 500,000 ED 3 times a day, as well as vitamins of group B, C, PP, etc.

Pregnant women with asymptomatic bacteriuria are given a course of oral antibiotics and antibacterial drugs: ampicillin 250 mg 4 times a day, amoxicillin 250 mg 3 times a day, cephalexin 250 mg 4 times a day, furagin 0.1 g 4 times a day.

In the treatment of chronic gestational pyelonephritis, it is possible to use physiotherapeutic methods: decimeter waves of low heat power and an UHF electric field on the projection area of the kidneys in the remission stage, this helps to improve blood flow and reduce inflammation in the upper urinary tract. There is a positive effect from the influence of sinusoidal modulated currents and galvanization of the kidney area. It is possible to use acupuncture in pregnant women, which makes it possible to reduce the amount of drugs (save only antibiotics and uroseptics), abandon the use of painkillers, antispasmodic, and general tonic drugs.

The provision of outflow can be carried out using percutaneous puncture nephrostomy (in pregnant women, the widespread use of this method is impractical) or lobotomy. In most cases, with early surgical intervention, it is possible to perform nephrostomy with decapsulation and excision of the purulent-destructive area of the affected kidney. Often, with bilateral purulent-destructive lesion of both kidneys, radical surgery of the foci of destruction in the more affected kidney in combination with nephrostomy has a positive effect on the inflammatory process in the second less affected kidney (in combination with adequate antibiotic therapy). When performed sequentially, organ-preserving kidney surgery in combination with rationally conducted antibiotic therapy, plasmapheresis not only eliminate all complications, but also make it possible to achieve physiological terms and methods of delivery. The indications for transferring a pregnant woman to a urological hospital for surgical intervention are:

In the treatment of acute purulent-destructive pyelonephritis in pregnant women, two main points are determined, these are complete drainage of the blocked kidney and effective antibiotic therapy.

pregnant women with torpidly flowing forms of acute pyelonephritis, resistant to antibiotic therapy;
recurrent course of acute pyelonephritis;
forced repeated catheterization of the ureter, which does not provide persistent subsiding of acute pyelonephritis;
all forms of acute pyelonephritis, developed against the background of diabetes mellitus, polycystic kidney disease and spongy kidney;
non-relieving renal colic, all the more complicated by fever;
all types of gross hematuria, including asymptomatic;
detection by ultrasound of a volumetric formation in the kidney (tumor, large cyst).

Indications for nephrostomy in pregnant women:

apostematous nephritis;
carbuncle or kidney abscess, when the affected area is limited to two segments and there are no clinical manifestations and complications of purulent-septic intoxication;
purulent-destructive pyelonephritis of a single kidney, regardless of the clinical stage of the process.

When assessing the severity of purulent-destructive pyelonephritis, one should always remember that when performing an operation of insufficient volume (nephrostomy), the development of severe complications, including death, is possible. Therefore, in some patients, it is justified to expand the indications for nephrectomy. The use of radical operations in the treatment of complicated and difficult-to-treat forms of purulent-destructive pyelonephritis in pregnant women contributes to the almost complete elimination of postoperative mortality.

Indications for nephrectomy surgery:

total damage to the kidney with carbuncles with abscess formation and purulent fusion of the renal parenchyma;
severe septic complications of acute purulent pyelonephritis that threaten the life of the pregnant woman and the fetus;
initial signs of bacteriological shock;
with purulent pyelonephritis, which developed against the background of diabetes mellitus with decompensation of the latter.

Nephrectomy is possible if there is a satisfactory anatomical and functional state of the opposite kidney. Pregnancy undoubtedly complicates the technical operation of the operation, especially with long periods of pregnancy, there are often inflammatory changes in the perinephric tissue, which complicates the process of kidney excretion, so special care must be taken during the operation. In the future, pregnant women who underwent nephrectomy revealed good compensatory capabilities, the function of the only kidney to remove nitrogenous toxins, maintain acid-base balance throughout the gestational period.

It must be remembered that in the postoperative period, pregnant women need special care and treatment. Of the antibacterial, combined etiotropic therapy is preferable, taking into account the results of urine and renal tissue culture on the microbial flora. For detoxification in the pre- and postoperative period, it is possible to use plasmapheresis. With the help of this method, there is a mechanical removal of bacteria, products of their metabolism, cryoglobulins, pathological immune complexes, autoantibodies and other substances that determine the degree of intoxication, in addition, plasmapheresis helps to eliminate the deficiency of cellular and humoral immunity, stimulates the production of fresh plasma and its entry into the bloodstream ... However, for the appointment of plasmapheresis, there is a certain list of indications:

all sluggish forms of acute pyelonephritis of pregnant women, accompanied by chronic intoxication, and especially with bilateral lesions;
complicated and severe forms of acute gestational pyelonephritis (toxic hepatitis with signs of hepatic renal failure, septic pneumonia, encephalopathy, metroendometritis, etc.);
acute gestational pyelonephritis of a solitary kidney;
acute gestational pyelonephritis, which has arisen against the background of diabetes mellitus, polycystic kidney disease.

Contraindications for plasmapheresis are anemia, hypoproteinemia with low blood pressure, as well as in the presence of viral hepatitis. When assessing the results of treatment, it is important, in addition to the disappearance of clinical symptoms, the absence of pathological changes in the urine tests during its triple study. In the future, the woman should be monitored by a urologist.

Pyelonephritis during pregnancy should be treated immediately after the diagnosis of the disease. The disease can lead to infection of the vital organs of the fetus.

What is pyelonephritis

Pyelonephritis is an infectious-inflammatory kidney disease caused by a pathogenic bacterium. "Pielo" means pus.

General urine analysis. The presence of leukocytosis and accelerated erythrocyte sedimentation is an indicator of inflammatory pro
cessa.
Biochemical analysis of urine - to identify the quantitative content of urea, creatinine and uric acid - the main indicators of urinary metabolism.
Urine analysis according to Nechiporenko. A visual examination of urine is not enough to confirm the diagnosis. The laboratory service determines the chemical composition of urine (protein, glucose, ketones). Microscopy shows a large number of leukocytes, bacteria, yeast. Cylinders may be present, confirming the development of the pathological process.
Bacterial urine culture to identify the pathogen and determine its sensitivity to drugs. The study is subject to urine taken with a catheter. In urine taken from the urethral opening, only cells and shaped elements of the urinary system are present. For example, if the analysis is incorrect, cellular elements from the vaginal mucosa enter the urine of a pregnant woman, which greatly complicates the identification of the pathogen.
- a method that allows you to get complete information about the structure of the organ, and all the processes taking place in it. With pyelonephritis of pregnant women in the kidneys, tissue heterogeneity, dilated pelvis and compaction of parenchyma areas are noted. Ultrasound allows you to determine the staging of the disease and the type (acute or chronic). With combined pyelonephritis, tomography with the introduction of a contrast agent is prescribed.

Treatment

Treatment of renal pathology in pregnant women is carried out only in stationary conditions.

The main treatment is antibiotic therapy. To select a drug, a test is carried out for the resistance of bacteria to groups of antibacterial agents. The most commonly prescribed are: gentamicin, amoxicillin, ampicillin. Antibiotics are administered by drip, less often in the form of tablets or suspensions.
To prevent the growth of fungal flora or dysbiosis, probiotics (acipol, bifidobacterin) are taken.
Antispasmodics (no-shpa) are definitely taken. Injections or tablets.
Pain relievers allowed during the period of childbearing.
To prevent the threat of premature birth or early termination of pregnancy - drip solution of magnesia, or capsules of magnesium-containing substances with.
Uroantiseptics - kanephron.

Treatment of pyelonephritis in pregnant women consists not only in taking medications:

... Physiotherapy procedures help to normalize blood flow to the pelvic organs and kidneys.
... For a pregnant woman with kidney pathologies, a "personal" mode of drinking water has been established - at least 3 liters per day. The liquid includes fruit drinks, compotes and juices.

Diet for pyelonephritis

With kidney disease:

Not: spicy dishes, salt, vinegar. Pickled foods, garlic, onions and spices.

Yes: lactic acid products, fresh vegetables, fruits, juices with vitamin C.

Reduce consumption of caffeinated beverages, moderate amounts of sugar.

Give preference to steamed or baked dishes. Fried, spicy salty - prohibited.

Video: pyelonephritis during pregnancy

Pyelonephritis is a pathology of the kidneys of an infectious origin, in which the structure of the organ is disrupted. Against the background of inflammation, the outflow of urine worsens, the disease is accompanied by pain, sometimes high fever. Pyelonephritis during pregnancy occurs often, it can be primary, but more often an exacerbation of chronic inflammation of the kidneys is diagnosed. How is pyelonephritis treated 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, pressure of the uterus on the kidneys, changes in hormonal levels. 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 leaves worse. Against the background of hormonal changes in the body, the tone of the muscles changes - urodynamics is disturbed, urine from the bladder is thrown back into the kidneys. If pathogenic microorganisms are present in the urine, an inflammatory process in the kidneys begins.

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

Inflammation of the kidneys in pregnant women is called gestational pyelonephritis - the disease develops during the gestation 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, carrying 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 only be made after tests.

Indications for hospitalization for pyelonephritis in pregnant women:

acute pyelonephritis, exacerbation of a chronic form;
renal failure;
preeclampsia, which develops against the background of kidney inflammation;
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 E. coli, bacteria. With the blood flow along 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, and buttocks. Urination becomes painful, the temperature rises sharply, sweating increases. In primiparous women, the disease may occur at 16–20 weeks, in multiparous women, at 25–32 weeks.

an increase in body temperature up to 38-39 degrees;
the urine becomes cloudy;
persistent lower back pain on one or both sides;
chills, pain in 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 a diagnosis. The development of an inflammatory process in the kidneys may be indicated by a dull pain in the lumbar spine, the presence of protein in the urine.

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

Important! Pyelonephritis is subject to compulsory treatment during pregnancy - antibiotics cause less harm. Not an inflammatory process in the kidneys.

How does pyelonephritis affect pregnancy? Pregnant women with kidney inflammation almost always have severe gestosis - this can cause serious consequences for the child.

Than pyelonephritis threatens during pregnancy:

premature termination of pregnancy - constant or severe pain syndrome stimulates the 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 into the tissues of the fetus, developmental pathologies arise;
oxygen starvation - against the background of pathological changes in the kidneys, fetal hypoxia and asphyxia occur.

If a woman has suffered pyelonephritis during pregnancy, then often newborns are low weight, prolonged yellowness, 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;
sowing urine to identify the type of pathogenic microorganisms - carried out three times;
a clinical blood test - a high ESR, low hemoglobin, a high content of immature leukocytes indicate inflammation;
Ultrasound, conventional and Doppler.

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

Important! Pyelonephritis is not one of the main indications for a cesarean section.

Features of treatment in pregnant women

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

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

Essential medicines for kidney inflammation:

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

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

Proper nutrition and adherence to the drinking regime are of great importance during treatment. A diet for pyelonephritis in pregnant women means 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. It is better to eat bread a little dried, giving preference to products made from wholemeal flour.

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

Treatment with folk remedies

Herbal medicine will help to enhance the effectiveness of medicines; plants that have diuretic and anti-inflammatory properties are used to treat pyelonephritis.

How to treat pyelonephritis with herbs? First you need to remember which plants are prohibited from using during pregnancy:

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

Broth of oats is a universal remedy for the treatment of kidney inflammation. It must be cooked from cereals - pour 180 g of cereal in 1 liter of water, simmer for 2-3 hours over low heat. You need to take oatmeal medicine on an empty stomach, 120 ml 2-3 times a day.

Pumpkin is a healthy vegetable with powerful anti-inflammatory effects. You need to make juice from it, cook porridge, use it raw and boiled.

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

Thyme infusion helps to quickly eliminate pain and inflammation. Pour 220 ml of boiling water with 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.

Prophylaxis

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 of chronic renal inflammation from 12-13 weeks, you can take urological phytopreparations - Kanefron N, Brusniver.

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

It is necessary to avoid hypothermia, not to visit crowded places during epidemics, regularly do gymnastics for pregnant women, swim, 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, following the doctor's recommendations will help to avoid exacerbation and recurrence of renal inflammation.

Pregnancy can both provoke the appearance of pyelonephritis and exacerbate its chronic course. Statistics show that 5-10 percent of women have a complication in the form of this disease during the period of bearing a child. Pregnancy can reduce the immune defense of a woman's body, which is the most important factor for the occurrence of this ailment.

Reasons for development

Chronic pyelonephritis is considered a disease that affects the pelvis and calyces of the kidneys - the areas of the body that are responsible for urination. Such a disease can be acute and chronic. Pregnancy in itself is not an ailment, but it is quite capable of provoking the development of various pathological processes and exacerbations, including chronic pyelonephritis.

Women during the period of carrying a baby need to be extremely attentive to their health if they already have a diagnosis of chronic pyelonephritis. During pregnancy, the expectant mother undergoes serious changes in the body, which are provoking for the inflammatory processes of the kidneys.

Provoking factors:

Under the influence of hormonal changes, there is a decrease in the tone of the bladder and a disorder in the movement of the walls of the ureters.
Congestion of lymph and blood.
The uterus increases in size, squeezing all internal organs, including the ureters.
Fluctuations in blood sugar.
Increased glucocorticoid levels.

Chronic is quite capable of exacerbating under the influence of such changes in the female body. These factors affect the outflow of urine, leading to its stagnation, which causes an inflammatory process of the kidneys.

In addition, during gestation, the placenta synthesizes the hormone estrogen in large quantities, which can contribute to the reproduction of pathogenic flora in this area. The veins of the ovaries also dilate, this leads to stretching of the renal pelvis and stagnation of urine.

Often, exacerbating pyelonephritis will remind of itself in the second half of pregnancy, since the enlarged uterus turns to the right and deviates slightly. This explains the fact that the right kidney is always more susceptible to pathology than the left. The ureter and kidneys, overloaded with urine, become inflamed, for this reason, chronic pyelonephritis is exacerbated.

It should be borne in mind that the body weight of the expectant mother plays an important role, if the weight of the pregnant woman is very low, then the likelihood of an exacerbation of this disease increases many times. This situation must be taken into account by the doctor. The doctor usually corrects the patient's nutrition in order to protect her from such an inflammatory process.

Infectious pathogens usually become:

Often, such processes occur in a woman's body only from the second trimester to 8 months of gestation, later the situation improves, as the child sinks, and the pressure on the kidneys weakens. A woman's body can fully return to normal only 4-5 months after childbirth.

Manifestations of the disease and possible consequences

The pathological process almost never manifests itself in the first stages of its development. There are no symptoms of this ailment, and the woman feels completely normal, although there may be mild pain in the lumbar region, as well as a slightly increased body temperature.

Signs

Often women do not attach much importance to the negative manifestations of any chronic diseases, because they think that this condition is caused by pregnancy itself, and such symptoms are not dangerous.

Signs of illness during pregnancy:

At the first manifestations of such symptoms, a woman should immediately consult a doctor. Pregnant women with chronic pyelonephritis are always treated in a hospital setting, home therapy is unacceptable.

Risks to the mother

In medicine, there are several degrees of risk that classify this ailment in relation to maternal mortality.

Grade 1 means that the disease occurred for the first time during the period of gestation, and pregnancy, in this case, is not contraindicated.
Grade 2 is diagnosed with chronic pyelonephritis that occurs before pregnancy. This means that such women are at a given mortality risk.

Only a doctor can assess the situation, separately in each case. Women with such a disease while carrying a baby will be unambiguously observed by a nephrologist and a therapist.

Sometimes this pathology is accompanied by additional ailments: anemia, hypertension, or the absence of one kidney. In this case, doctors will advise the woman to refuse pregnancy altogether. Many representatives of the fairer sex do not listen to doctors and decide to give birth, despite the contraindications, then they will have to sign a large number of papers reporting a high risk. In addition, pregnancy burdened with such diseases can lead to death of the expectant mother and child.

Expectant mothers should soberly assess the risk to their health, as well as to the health of the child, if they are sick with chronic pyelonephritis. Problems can arise at any time, and even after the birth of the baby. If a woman nevertheless decides to give birth, then you need to take your health as seriously as possible, at the first signs of an exacerbation of the disease, go to the doctor and start treatment.

With an advanced pathological process, serious consequences are very likely, even treatment may become useless.

Therefore, you need to constantly be monitored by a doctor and take the necessary tests.

Risks to the child

What is the threat to the fetus of pyelonephritis detected in the mother? This could be:

Such a pathology is no less dangerous for the expectant mother. The inflammatory process can spread to all nearby tissues, and this leads to glomerulonephritis and renal failure.

A particularly severe course of this disease sometimes leads to kidney abscess and phlegmon, which is deadly.

Treatment and prevention of exacerbation

Therapy for exacerbation of chronic pyelonephritis is based on ensuring the safety of a pregnant woman and her fetus. The doctor carefully analyzes the situation, weighs the possible negative effects of drugs and the degree of risk.

Most often, exacerbation of chronic pyelonephritis during pregnancy is treated with the following drugs:

Before choosing antibacterial drugs, it is necessary to take a urine test from a woman in order to sow the causative agent of the infection. Only after that it becomes clear which antibiotic will be effective in the treatment of such a pathology.

In addition, such patients need to be administered intravenously Reopolyglucin, as a detoxification therapy. Hemodesis is also quite effective.

Childbirth in such women should be natural, a cesarean section is undesirable in the presence of infectious processes in the body of a pregnant woman. In extreme cases, in the presence of certain indications, a cesarean section is still performed.

Expectant mothers who suffer from chronic pyelonephritis must without fail:

All food should be healthy. You also need to exclude from your diet highly concentrated broths from mushrooms, fish, meat. You can add these broths in small portions to soups with cereals and vegetables.

The main condition that such patients must observe is the minimum intake of salt, since this substance retains fluid in the body.

This disease is very dangerous, especially during the period of bearing a child. With the timely assistance of doctors, as well as the observance of all preventive measures, this chronic pyelonephritis in pregnant women will not harm either the expectant mother or the fetus. It is very important to start treatment of exacerbation as early as possible, then the prognosis will be favorable. The first signs of this pathology should alert the woman and prompt her to take immediate action. The doctor will select the right therapy and the problem will be solved.