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Pyelonephritis is an insidious disease during pregnancy. Pyelonephritis in pregnant women

It is an inflammatory kidney disease that affects the renal pelvis and calyces. Pathology occurs quite often in women, about 10% of all cases are pregnant. And there is an explanation for this - during the gestation period, the woman's body becomes vulnerable to infections, and the load on the kidneys increases greatly.

Gestational pyelonephritis is classified as a severe complication of pregnancy, so women are advised to be attentive to their condition and take it regularly for prevention. At the first signs of the onset of pyelonephritis, you must go to the hospital.

Causes

Pyelonephritis refers to diseases of an infectious and inflammatory nature. The main reason for the development of pathology is the infection in the kidneys. Various microorganisms can provoke pyelonephritis during pregnancy, most often it is opportunistic bacteria:

  • colibacillus;
  • staphylococci;
  • streptococci, etc.

The causative agents can also be sexually transmitted infections, as well as viruses and fungi.

There are also a number of predisposing factors that help the infection develop:

  • Hypothermia. Due to vasoconstriction, it reduces the immune response.
  • Alcoholism, smoking.
  • Eating a lot of spicy and fatty, salty foods. Such a diet irritates the bladder and kidneys.
  • A woman's history of chronic cystitis or pyelonephritis.

Acute pyelonephritis occurs frequently during pregnancy due to changes in the woman's hormonal background. In order to preserve gestation and allow the baby to develop normally, the body carries out a physiological decrease in immunity. Therefore, a woman becomes more susceptible to various diseases of an infectious and inflammatory nature.

If prophylaxis was not carried out before conception, most likely chronic pyelonephritis during pregnancy will worsen. And the reason is not only a weakening of immunity, but also an increase in the load on the urinary system.

As the amount of fluid in a woman's body increases due to the abundant production of blood and amniotic fluid, there is more urine. The renal pelvis and cups expand, and more urine accumulates in them. This increases the risk of developing inflammation.

Symptoms

Acute pyelonephritis has pronounced symptoms:

  • high body temperature;
  • back pain, increased pain when tapping in the kidney area;
  • increased urination;
  • high blood pressure;
  • change in color, smell and amount of urine;
  • deterioration of the general condition, nausea and dizziness, weakness may appear.

Chronic pyelonephritis during pregnancy can be asymptomatic for a long time. The pain is mild, often similar to training contractions, so a woman may not pay attention to them.

As the amount of fluid increases, and the kidneys cannot excrete it normally due to the inflammatory process, edema occurs. They are especially noticeable in late gestation, in the 3rd trimester.

It is possible to detect impaired renal function at an early stage; for this, women are recommended to take a general urine test every week or two and visit a gynecologist for examination and consultation. Monitoring the weight and quality of urine will help determine the onset of the development of the pathological process and promptly start treating it.

Treatment of pyelonephritis in pregnant women

Pyelonephritis during pregnancy is a serious illness that should only be treated in a hospital. In the later stages, a woman should be under the supervision of an obstetrician-gynecologist, since in case of complications, in particular, the development of gestosis, an emergency caesarean section may be required.

Antibacterial drugs are the mainstay of therapy for gestational pyelonephritis. Such funds are selected by the doctor on an individual basis. Usually, drugs of the following groups are prescribed:

  • fluoroquinolones;
  • cephalosporins;
  • penicillins, etc.

As symptomatic therapy, antispasmodics are prescribed, for example, suppositories with Papaverine or No-shpu. These products help relax smooth muscles and improve urine flow, and reduce uterine tone, reducing the risk of preterm labor.

To relieve high fever and pain, non-steroidal anti-inflammatory drugs are prescribed, for example, Paracetamol, Nurofen. Sedatives, immunostimulating drugs, vitamins can also be shown.

When treating gestational pyelonephritis with antibiotics, the risk of developing vaginal candidiasis increases. Therefore, for prophylactic purposes, an antifungal agent is prescribed, for example, Nystatin or a combination drug such as Neo-penotran, Polygynax, etc.

In the complex treatment of pyelonephritis in a pregnant woman, herbal preparations with anti-inflammatory and diuretic effects are prescribed. The most popular and approved drug during pregnancy is Kanefron.

During the treatment of pyelonephritis, a pregnant woman should observe the following recommendations:

  • completely exclude alcohol from the diet, in any quantity and form;
  • remove salty, spicy, smoked, fried and fatty foods from the diet;
  • if there is no edema, then you need to drink at least 2 liters of water per day, and in the presence of edema, the doctor recommends the amount of fluid, and these tips must be strictly followed;
  • to improve the outflow of urine, it is recommended to get up in the knee-elbow position several times a day, so the uterus stops pressing on the urinary tract.

In severe and advanced cases, with the development of an abscess, surgical intervention may be indicated, up to and including removal of the kidney. Also, in a severe case, termination of pregnancy may be indicated if pyelonephritis develops at an early stage. Or, an emergency delivery may be prescribed.

Folk remedies

It is necessary to treat pyelonephritis during pregnancy strictly under the supervision of a doctor in a hospital setting. There can be no question of any self-medication with folk remedies. This is not only useless, but also dangerous for the life of the mother and child and can lead to very serious consequences.

Also, some herbs should not be taken during pregnancy. They can cause an active contraction of the uterus and premature birth, or provoke the development of diarrhea, an allergic reaction, which also does not have the best effect on a woman's health.

  • decoction of lingonberry leaf;
  • lingonberry juice;
  • cranberry juice.

Berry fruit drinks are especially useful, since they not only contribute to the elimination of excess fluid, but also saturate the body with useful vitamins, which has a beneficial effect on the woman's immune system.

A safe and beneficial remedy is chamomile tea, which relieves pain and has a calming effect. It is especially important to drink chamomile tea at night to improve sleep.

Consequences of pyelonephritis for a child

As a rule, pyelonephritis of a bacterial nature goes through several stages. First, an acute inflammatory process develops. If untreated, small abscesses form in the affected area, which gradually merge into one large abscess and represent a kidney abscess.

This condition is very life-threatening, as pus fills the entire kidney, and infection can enter the bloodstream and cause sepsis. All these complications are fraught with death for the patient, or disability.

It is important to note that with timely treatment, the prognosis of pyelonephritis in a pregnant woman is favorable. The sooner the pathology is diagnosed, the more chances to avoid complications.

Sometimes pyelonephritis during pregnancy can give complications even before the development of an abscess, during the acute course of the disease:

  • a strong increase in blood pressure and a deterioration in the condition of a woman;
  • development of uterine hypertonicity and premature birth;
  • spread of infection to the pelvic organs and intrauterine infection of the fetus;
  • development of renal failure, acute urinary retention;
  • development of preeclampsia, severe edema, threat to the life of the mother and fetus.

Especially often pyelonephritis in pregnant women provokes the development of gestosis in the later stages. This condition leads to a malnutrition of the fetus and the development of hypoxia. Lack of oxygen can lead to impaired development of the fetus and even its death.

Prevention of kidney pathologies during pregnancy

To avoid pyelonephritis during pregnancy, it is recommended:

  • regularly undergo examination at the antenatal clinic and take a weekly urine test;
  • avoid hypothermia;
  • give up junk food, follow a balanced diet;
  • moderate physical activity is required;
  • drink enough water;
  • visit the toilet regularly, do not tolerate the urge to urinate.

It is very useful for pregnant women to do special exercises and walk for at least an hour a day. This is necessary for the circulatory system to function well.

Women who have a history of chronic kidney and bladder pathology should also observe the drinking regime from the first days of gestation, and also regularly visit a specialist. At the first signs of an exacerbation, you should immediately consult a doctor.

Conclusions.

Gestational pyelonephritis is a common condition, so every pregnant woman should be monitored. Even if there were no kidney problems before, they can occur during gestation, especially with multiple pregnancies. It must be remembered that the health of the fetus largely depends on the behavior of the mother and on the state of her health.

About 7% of pregnant women suffer. The disease can disrupt the normal course of pregnancy and fetal development. Given the severity of pyelonephritis, every pregnant woman needs to undergo a urine test several times during the entire pregnancy in order to notice the precursors of kidney disease in time.

Causes of pyelonephritis in pregnant women

Pyelonephritis is an inflammation of the renal pyelocaliceal system. The inflammation is caused by bacteria. In approximately 80% of cases, pyelonephritis is provoked by opportunistic flora: E. coli, Enterobacter, Klebsiela, - and. Less commonly, the culprits of the disease are,. Bacteria enter the kidneys either from the lower urinary organs (urethra, bladder), or through the bloodstream are brought in from foci of chronic infection.

Changes in the female body during pregnancy contribute to the progression of the inflammatory process in the kidneys. So, hormonal changes with increased synthesis lead to a decrease in the tone of the ureters, bladder, renal cups and pelvis. This causes a slowdown in the flow of urine and its stagnation, which can be considered ideal conditions for the growth of bacteria.

In addition, the enlarged uterus puts strong pressure on the ureters, which also causes a violation of the proper passage of urine. That is why pyelonephritis often occurs at the end of the second trimester (at 22-26 weeks), when the uterus is already greatly enlarged in size.

When a pregnant woman falls ill with pyelonephritis for the first time in her life, they talk about development gestational pyelonephritis... There are also situations when a woman had chronic pyelonephritis even before conceiving a child, and during pregnancy, the disease worsened. Regardless of the form of the disease, the applied treatment is the same.

Symptoms of pyelonephritis in pregnant women

Pyelonephritis in pregnant women can proceed in different ways. So, for acute pyelonephritis the symptoms of the disease are pronounced, the general well-being worsens. Chronic pyelonephritis proceeds, as a rule, with little symptoms and an inflammatory process can be suspected only if certain abnormalities in urine tests are detected.

Acute pyelonephritis accompanied by an increase in temperature, which can reach very high numbers. The woman feels overwhelmed and tired. She may be bothered by chills, headaches. At the same time, it appears, which can be more pronounced on the one hand. The pain can be given to the lower abdomen, thigh, groin. If pyelonephritis is accompanied by inflammation of the lower urinary organs, the woman is also worried about the frequent urge to urinate, a burning sensation at the same time.

Chronic pyelonephritis can only make itself felt with a slight increase in temperature, rapid fatigue, and discomfort in the lower back. In case of exacerbation, the symptoms of pyelonephritis become more pronounced. Often, pregnant women do not suspect they have a disease. In this case, women learn from the doctor about the existing pyelonephritis only after the results. When examining urine, leukocytes, bacteria, and also a small amount of protein are determined in it.

Pyelonephritis is not at all a harmless disease. The inflammatory process complicates the course of pregnancy, childbirth and can even lead to impaired fetal development.

The complications of pyelonephritis in pregnant women include:

  • Late gestosis ();
  • Miscarriage of pregnancy;
  • Fetal infection;
  • Fetal hypotrophy.

Treatment of pyelonephritis during pregnancy

If acute pyelonephritis is detected, the patient is admitted to the hospital... This is a prerequisite, since a woman must comply with bed rest, and therapy must be carried out under the supervision of an obstetrician-gynecologist or nephrologist.

The basis of treatment is the appointment, only these drugs are able to destroy the bacteria that caused pyelonephritis. In the treatment of pregnant women, the safest antibiotics are used, namely:

  • Penicillins (Ampicillin, Oxacillin);
  • Cephalosporins (Cefuroxime, Cefoperazone);
  • Macrolides (Josamycin, Azithromycin).

In the first trimester of pregnancy, when the organs of the fetus are still being formed, penicillins are preferred in the treatment of mothers.... From the second trimester, macrolides and cephalosporins are already prescribed. The duration of antibiotic treatment is on average ten to fourteen days.

Important!Antiseptic drugs from the group of nitrofurans (Furagin) are prescribed together with antibiotics. Herbal uroantiseptics (Canephron) are used as an additional treatment. These drugs alone will not be able to defeat pyelonephritis without antibiotics.

In the presence of intoxication of a pregnant woman, detoxification therapy is performed. To restore the passage of urine, a woman is prescribed antispasmodics (Drotaverin, Papaverine). In addition, laying the pregnant woman on her healthy side with raising her legs contributes to a better outflow of urine. For the same purpose, a woman is recommended to take a knee-elbow position for ten minutes several times a day. At this time, you can leaf through a magazine, watch a tablet to pass the time.

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! It is necessary to take urine for analysis 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.

Pregnancy is an important stage in the life of every woman, which lasts 9 months and ends with the birth of a long-awaited baby. Unfortunately, bearing offspring also serves as a stress factor for the body, as a result of which many chronic diseases that are in a dormant mode are exacerbated. The first signs of pyelonephritis during pregnancy are not known to everyone: this explains the low number of visits to a specialist. To protect yourself and your baby from possible complications and negative consequences, you must regularly take tests and monitor your health throughout pregnancy.

What is pyelonephritis during pregnancy

Pyelonephritis is an inflammatory disease of the renal pyelocaliceal apparatus, which is caused by bacteria and can manifest itself at any stage of pregnancy. The disease can be both acute (first appeared and lasting from two to five days) and chronic (with constantly alternating phases of exacerbation and remission). The main triad of symptoms consists of increased blood pressure, back pain, and the appearance of protein with bloody impurities in the urine.

Knowledge of the anatomy of the kidneys will help to understand the causes of pyelonephritis.

A normal kidney consists of several small cups, united into larger pelvis, from which urine is sent through the ureter to the bladder. This structure provides better filtration of all fluid in the body. During pregnancy, the enlarged uterus slightly presses on the organs of the urinary system, thus provoking congestion. This creates optimal conditions for the growth and development of pathogenic microflora.

Causes of the disease

Pyelonephritis is a disease that is caused mainly by bacterial pathogens. The most frequently met representatives are:

  • staphylococcus;
  • streptococcus;
  • Proteus;
  • Pseudomonas aeruginosa;
  • klebsiella;
  • colibacillus;
  • enterococcus;
  • some types of protozoa.

And it is also necessary to take into account external and internal factors that increase the risk of developing inflammatory processes in the body. It:

  • recently transferred operations;
  • traumatic injuries of the abdominal and retroperitoneal organs;
  • sedentary lifestyle;
  • frequent change of climatic zones;
  • the presence of chronic diseases (HIV, hepatitis, syphilis, tuberculosis, diabetes mellitus, hypertension, endocrine pathologies);
  • anomalies in the development of the genitourinary system (absence of the ureter, doubling of the kidneys, underdevelopment of the bladder);
  • reflux of urine into the pelvic-cup system;
  • unprotected intercourse with a large number of sexual partners;
  • violation of the rules of sanitary culture and personal hygiene;
  • low awareness of the state of their own health.

The causative agent of pyelonephritis enters the body of women in three ways: through the blood, lymph fluid and urethra. Most often, the first type of transmission occurs, and the source of infection can be located anywhere in the body.

For example, untreated caries or a festering scratch can be the direct cause of the development of pyelonephritis.

After entering the human body, the bacterium settles in the lymph nodes, where the first cycle of its reproduction begins, which ends with migration into the bloodstream. With the flow of fluid, it reaches the renal system, affecting the pelvis and calyx. In this place, active processes of damage and cell death begin, which is accompanied by swelling of the organ, causing the first pain syndrome. The kidneys perform their function much worse, edema and signs of uremic intoxication of the body develop: nausea, vomiting, general weakness and sleep disturbances. At a later stage, the proliferation of connective tissue occurs in the place of dead cells - this is how acute or chronic renal failure develops, which can cause the death of the patient and the fetus.

Symptomatic manifestations of pyelonephritis while carrying a child

All general and local signs of pyelonephritis quite often add up to a picture that allows one to suspect a diagnosis. The typical form of the disease begins with intoxication, which is then joined by the symptoms of renal damage, but in cases of complicated pyelonephritis, everything can be quite the opposite.

In his clinical practice, the author of this article came across a case when a pregnant woman complained of a child's hyperactivity during the urination process. The kid began to kick violently, causing significant discomfort. This forced the girl to visit a doctor, as a result of which she was diagnosed with bilateral pyelonephritis.


Low back pain - a common symptom of pyelonephritis

Local manifestations of the disease include:

  • pulling pain in the lumbar region;
  • redness and clouding of urine, the appearance of clots and foreign impurities in it;
  • urinary disorders: urine retention, cramps, burning and itching, discharge of urine drops;
  • increased blood pressure;
  • the appearance of puffiness in the face area.

Swelling of the face indicates the accumulation of fluid in the body.

Generalized signs of kidney inflammation:

  • weakness, lethargy, severe fatigue;
  • headaches and dizziness;
  • appetite disorders;
  • poor sleep;
  • temperature increase;
  • apathy and depression;
  • irritability;
  • tiredness in the evening;
  • decrease in efficiency;
  • low endurance.

Table: characteristics of the symptoms of pyelonephritis at different stages of pregnancy

Comparative clinical sign First trimester (1-13th week) Second trimester (14-27th week) Third trimester (28 to 40 weeks)
Temperature increase up to 37-38 degrees 38-39 degrees up to 40 degrees
The appearance of protein and blood in the urine up to 1 gram per liter 1-3 grams per liter more than 3 grams per liter
The rise in blood pressure above normal by 20-30 mm Hg practically uncharacteristic occurs in 40-60% of all patients the majority of patients (up to 90%) suffer from hypertensive crises and periodic loss of consciousness
Urinary disorders inability to completely empty the bladder, feeling full discomfort during urination associated with impaired urine discharge false urge, itching and burning in the urethra
Pain syndrome localized in the region of the kidneys, aggravated by stress and physical exertion in the umbilical region with kickback in the groin and upper thigh felt evenly over the entire surface of the back below the edge of the shoulder blades, can give off to the navel

Diagnostic techniques

The first doctor to whom a woman will turn with her complaints is an obstetrician-gynecologist. He further redirects the patient to a nephrologist. The specialist begins work with farrowing: the patient is required to describe in as much detail the time of the onset of the first symptoms and their characteristics as possible, to describe the previous treatment. If the disease existed before pregnancy, it is necessary to clarify the timing of the last exacerbation and its duration.

It is believed that the tendency to develop kidney disease is inherited. Women whose immediate family has suffered from pyelonephritis are twenty percent more likely to develop this condition.

After the end of the conversation and clarification of the main complaints, the doctor proceeds to the examination. The pregnant woman is asked to undress to the waist and is carefully examined. The development of inflammatory pathology in the body is evidenced by:

  • pallor and dryness of the skin and mucous membranes;
  • seizures in the mouth;
  • bruising under the eyes;
  • swelling of the neck and face;
  • whitish coating on the tongue.

And also a specific method for diagnosing pyelonephritis is to check Pasternatsky's symptom. To do this, the doctor places the palm of one hand on the lower edge of the costal arch on the back, after which he strikes it with the fist of the other hand. With the development of the inflammatory process in the kidneys, the pain intensifies and migrates in the opposite direction.

What diseases are most often confused with ailment

Pyelonephritis is a fairly common disease from the group of renal pathologies that occur in most of the population. They have an extremely similar clinical symptomatology, which greatly complicates the diagnosis. Many patients unconsciously ignore their complaints or seek help from a completely different specialist who cannot correctly understand and read the clinical signs.

Most often, pyelonephritis in pregnant women is differentiated with the following ailments:

  • cystitis;
  • urethritis;
  • glomerulonephritis;
  • kidney cyst;
  • malignant and benign diseases of the pelvic organs and retroperitoneal space;
  • ectopic pregnancy;
  • miscarriage;
  • symptomatic arterial hypertension and essential hypertension;
  • eclampsia and preeclampsia;
  • diabetic, paraneoplastic, toxic, drug, alcoholic nephropathy;
  • overdose of drugs or drugs;
  • tuberculosis of the genitourinary system;
  • urolithiasis.

Laboratory research for pyelonephritis

To get as much information as possible about the health of a pregnant woman, it is necessary to regularly evaluate all tests. For this, blood and several types of urine tests are donated. After a couple of days, the doctor receives all the results, based on which it can be concluded that the calyx-pelvic system is damaged.


Blood in the urine is a formidable sign of the development of an ailment.

Most often they are prescribed:

  1. A complete blood count is a standard screening test that is performed on all patients who come to the clinic for further examination. With pyelonephritis, pronounced inflammatory changes are observed: an increase in leukocytes, lymphocytes, neutrophils, macrophages, erythrocyte sedimentation rate and C-reactive protein. There may also be phenomena of anemia with low hemoglobin and platelets.
  2. Urine analysis according to Nechiporenko is carried out when examining the first morning portion of urine. It is thoroughly mixed with a glass rod, placed in special chambers, where all the same cellular elements are counted under a microscope. During pyelonephritis, there is always an increase in leukocytes from two thousand, erythrocytes - more than a thousand, and cylinders - more than twenty units.
  3. General urine analysis evaluates primarily physical properties. Normal urine has a straw-yellow color, moderate density and transparency. The inflammatory process is manifested by the appearance of blood or even clots, clouding of urine, and the formation of a crystalline precipitate. And you can also identify the presence of pathogenic microorganisms in this way.
  4. Bacteriological urine culture. After microscopy of the urine sediment, it is transferred to various nutrient media using a cotton swab. After a few days, the bacterial growth rate is assessed. So it becomes possible to find out which pathogen is the cause of the infection, as well as to choose a specific treatment.

Instrumental research in the disease

Thanks to the achievements of modern medicine, it becomes possible to assess the condition of the kidneys without resorting to invasive surgical methods. Instrumental examination methods cannot replace laboratory ones, but they are an excellent addition to confirming the diagnosis of pyelonephritis. Unfortunately, their use during pregnancy is also limited. The most commonly used methods are:


The main methods of treating pyelonephritis during pregnancy

Therapy of inflammatory diseases in the calyx-pelvic system is a rather lengthy and laborious process, which is largely complicated by the fact that most standard drugs are prohibited from taking during pregnancy. There is a strong emphasis on traditional medicine and herbal medicine. Changes in eating habits and drinking regimes also have a beneficial effect on a woman's health.

Important principles of pyelonephritis therapy during childbearing:

  • reduction of pain syndrome;
  • normalization of blood pressure;
  • stimulation of the activity of cells of the immune system;
  • removal of excess fluid from the body;
  • restoration of water-salt and acid-base balance;
  • no negative impact on the fetus;
  • destruction of the bacterial pathogen that provoked the appearance of the infection.

Medicines for the treatment of ailment

During pregnancy, the mother's body perceives many substances as foreign components. They can also seriously affect the development of a small person, disrupting the maturation of his organs and tissues. Most often, the nervous, endocrine, respiratory systems suffer from the use of medications, and external deformities and deformities of the facial skull also appear.

In the practice of the author of this article, there were clinical cases when women independently prescribed and canceled antimicrobial drugs for themselves. Unfortunately, in the overwhelming majority of cases, children were born with serious impairments of hearing, sight, smell, a deep cleft of the upper palate or non-closure of the openings in the atrial septum occurred, which led to a violation of the normal blood flow.

The best way to fight the causative agents of pyelonephritis are antibiotics: they kill pathogenic microflora, preventing further reproduction and development of the microbe in the cells of the body. When using these groups of drugs, there is no toxic effect on the baby:

  1. Penicillinins: Benzylpenicillin sodium and potassium salt, Bicillin-1, Bicillin-5, Oxacillin, Ampicillin, Ampiox, Flemoxin, Dicloxacillin, Azlocillin.
  2. Cephalosporins: Cephalexin, Cefazolin, Cefaclor, Cefuroxime, Cefpir, Cefepim, Cephobid, Rocefin, Fortum, Claforan, Ceclor, Vercef, Keflex, Zinnat, Zinacef.
  3. Macrolides: Erythromycin, Roxithromycin, Clarithromycin, Midecamycin, Macropen, Klacid, Rulid, Oleandomycin phosphate, Lincomycin.

Other groups of drugs used to treat the disease:

  1. Herbal remedies that gently remove excess fluid, toxins and toxins from the body. These include Kanefron, Cyston, Phytolysin, renal preparations for pharmacy preparation.
  2. Antihypertensive drugs are used to reduce hypertension and lower blood pressure to normal levels. In obstetrics and gynecology, Verapamil, Diltiazem, Labetalol, Norvask, Captopril, Enalapril are used.
  3. Stimulants of the immune system help to activate the internal reserves of the body and direct the forces of cells to fight against the causative agent of the infection. The most commonly used are Timalin, Timogen, Taktivin, Cycloferon and human immunoglobulin preparations.
  4. Diuretics include Urea, Mannitol, Triamteren, Indapamide, as well as any mineral waters and fruit and vegetable fruit drinks.

Photo gallery: antibiotics and other drugs used to treat pyelonephritis

Ampicillin is well tolerated during pregnancy Ceftriaxone needs to be dissolved in novocaine Erythromycin helps to remove microorganisms Canephron has anti-inflammatory, antispasmodic, antiseptic and diuretic effects
Captopril is used to treat hypertension Indapamide removes excess water from the body and lowers blood pressure

The nutritional culture of pregnant women is a separate science, the basics of which must be learned at school for expectant mothers. It is worth noting that with inflammation of the renal calyx system, you will have to give up the usual style of eating. All dishes must be baked, boiled or stewed: fried, smoked and dried delicacies should be excluded from the diet. The number of meals during the day is at least five: breakfast, lunch, dinner, several hearty and healthy snacks. It is also imperative to observe the drinking regime, consuming at least two liters of clean water per day.

Possible breakfast options:

  • porridge in water or milk (rice, oatmeal, oatmeal, buckwheat, millet) with the addition of berries, honey or nuts;
  • cottage cheese at least five percent fat with sour cream;
  • plain yoghurt and cheese and butter crispbread.
  • soup (pea, chicken, mushroom, hodgepodge, borsch, cabbage soup, cream, cheese, mashed potatoes) with a few slices of whole grain bread;
  • stewed vegetables in their own juice;
  • fish, meat platter.

What you can eat for dinner:

  • durum pasta with goulash;
  • boiled potatoes with chicken breast;
  • baked vegetables or turkey stew;
  • salmon with buckwheat porridge.
  • yogurt, cottage cheese, kefir, fermented baked milk;
  • fresh fruits;
  • nuts;
  • muesli;
  • bitter chocolate.

What is strictly prohibited to use during pyelonephritis:

  • chips, crackers;
  • fast food;
  • carbonated drinks;
  • any alcohol;
  • semi-finished products;
  • custard noodles;
  • industrial sweets;
  • black coffee.

Fast food has a bad effect on metabolism Coffee raises blood pressure Chips contain a lot of salt

Traditional medicine as an adjuvant

It has long been known that natural recipes are used by women around the world in order to alleviate their current condition and not harm the baby. Many deliberately refuse to take traditional medicines, completely replacing them with various teas and decoctions. This behavior is not correct, since all traditional medicines help get rid of only clinical symptoms, but are practically unable to affect the life cycle of the bacteria that causes pyelonephritis.

The main advantages of natural remedies:

  • cheapness;
  • ease of preparation and use;
  • the ability to independently collect ingredients;
  • minimal harm to the health of mother and child;
  • good effect from application.

The disadvantages include:

  • the possibility of allergic reactions;
  • individual intolerance during pregnancy;
  • rapid loss of effect upon discontinuation of use.

Traditional medicine recipes that help to cope with the manifestations of pyelonephritis during pregnancy:

  1. Take three large carrots and two beets, and use a juicer to make juice. Dilute 200 ml of juice with 100 ml of hot water and drink on an empty stomach. Beets and carrots not only contain a large amount of vitamins, but also have a pronounced stimulating effect on the immune system of the human body, forcing it to fight bacteria. This juice must be consumed within two months.
  2. Brew three bags of pharmacy chamomile in a half-liter mug of boiling water. After cooling down, drink the solution in small sips. The procedure is best carried out at a time when you do not plan to be away from home for a long time: chamomile has a mild diuretic effect, removes harmful toxic substances and toxins from the body.
  3. Throw 200 grams of chopped burdock leaves into a saucepan with a liter of hot water and cook over low heat, stirring clockwise. Once the liquid has cooled, divide it into three equal servings to be drunk throughout the day. Burdock leaves are great for treating inflammation.

Photo gallery: traditional medicine for pyelonephritis

Beets and carrots contain many nutrients Chamomile stimulates urination Burdock relieves inflammation

Video: competent therapy for kidney inflammation during pregnancy

Predictions and possible complications of the disease

Pyelonephritis is a rather formidable ailment of an infectious nature, the improper treatment of which negatively affects the health of both the mother and the child. That is why most pregnant women are treated in a hospital setting, and not at home. This reduces the percentage of maternal and infant mortality by two to three times.

If necessary, patients are issued a sick leave for up to fifteen days. The decision to extend it is made by a medical commission.

Disability is prescribed only for patients with chronic pyelonephritis, which has existed for a long time. The first group is reserved for people with severe renal failure who cannot exist without monthly dialysis procedures - blood purification using special devices. In this case, carrying a pregnancy is out of the question. The second group of disability is assigned in chronic pyelonephritis with frequent exacerbations and complications, as well as the initial form of kidney failure. Pregnancy usually ends with a caesarean section. Persons in the third group experience periodic urination disorders and can give birth on their own.

Possible complications of pyelonephritis in pregnant women:

  • acute or chronic kidney failure;
  • gestosis and toxicosis;
  • peripheral circulatory disorders;
  • thrombosis and thromboembolism of the great vessels;
  • infectious toxic shock and the development of sepsis;
  • premature birth, early miscarriages, stillbirths;
  • intrauterine infection of the fetus;
  • anomalies in the formation of the nervous, cardiovascular, respiratory and endocrine systems in an infant;
  • death of a child in the late and early stages.

Prevention of pyelonephritis during pregnancy

During the period of carrying a baby, a woman is especially vulnerable and susceptible to the influence of various pathogenic microflora. Any hypothermia, prolonged exposure to cold, or accidentally caught infection can cause pyelonephritis. Unfortunately, most environmental factors have a significant effect on the body, and it is not possible to completely remove them. However, at present, a system of preventive measures aimed at protecting women's health is widely used.

In his practice, the author of this article has repeatedly come across various stages and types of pyelonephritis in pregnant women. After treatment, all patients were prescribed specific prophylaxis and given some recommendations for correcting their usual lifestyle. Those who were able to give up bad habits and change their eating habits did not have recurrences of pyelonephritis. In others, on the contrary, the course of the disease was complicated by the formation of stones in the kidneys and ureters.

  1. Give up bad habits. Alcohol, nicotine and drugs used during pregnancy not only cause fetal growth retardation and the risk of premature birth, but also cause a serious blow to the health of the entire body. Cigarette smoke causes vasospasm, which is responsible for nourishing the kidneys, and the ethyl alcohol in alcohol disrupts the formation of healthy cells.
    Drinking alcohol during pregnancy is unacceptable
  2. Maintain your hygiene. It is known that a huge number of pathogenic microorganisms live in the area of ​​the vagina, urethra and anus, which can be carried back into the renal pelvis with the flow of urine. That is why it is so important to take a daily morning and evening shower or bath, use thin pads for secretions, and change bed and underwear. Remember that ordinary gels and shampoos are not suitable for intimate hygiene and can disrupt the vaginal microflora, provoking dysbiosis. It is recommended to purchase a special soap for this purpose at the pharmacy.
  3. Get pregnant gymnastics. Many women believe that waiting for childbirth is a process during which you can relax as much as possible and not maintain the desired physical shape. However, exercise not only has a tonic effect on the muscles, but also helps to reduce venous and arterial congestion in the pelvic area. You can practice both at home and in group training with a master. An additional plus to general physical education will be an exercise with a fitball: it also helps to better prepare for the upcoming birth.
    Exercise helps to keep the body in good shape
  4. Always dress appropriately for the weather. Pregnant women are much more susceptible to the development of colds and viral diseases that attack the body during hypothermia. If you spend a lot of time outdoors, choose long down jackets or fur coats, warm jackets and sweaters made of natural wool.
  5. Treat the existing purulent-inflammatory diseases before planning pregnancy. As mentioned earlier, caries, carbuncle, boil, or even an old scratch can serve as a source of bacterial microflora in pyelonephritis. Doctors strongly recommend that you undergo a complete medical examination to identify and eliminate such ailments. If necessary, the woman is prescribed antibiotic therapy for up to two weeks. After carrying out all the activities, you can safely start planning your pregnancy.
    Caries treatment should be done before pregnancy.
  6. Pass the necessary tests and participate in screenings. It is believed that a system of regular testing of blood and urine will detect even the earliest stage of pyelonephritis. It is necessary to register with the antenatal clinic of your polyclinic within a period of up to twelve weeks. If you fall ill with pyelonephritis in the late stages, the first step is to notify your doctor.

It is one of the most common diseases of pregnant women, it poses a danger to the health of the mother and child. It occurs in every tenth pregnant woman, in some cases leads to severe complications, both during and after pregnancy.

To this we can add that pregnancy itself is a provoking factor leading to the development of acute forms of pyelonephritis. Of course, this causes a more severe course of already formed chronic kidney disease.

Why is chronic pyelonephritis exacerbated during pregnancy?

During pregnancy, some of the body's functions change, which can provoke disease.

The main reason is the violation (more precisely, the complication) of the passage of urine, due to changes in the location and size of the uterus, as well as the effect of progesterone on the internal receptors of the urinary tract.

The uterus (in the second half of pregnancy) deviates somewhat and turns to the right, putting pressure on the right kidney. This, by the way, explains the fact that with an exacerbation of pyelonephritis in pregnant women, as a rule, it is the right kidney that suffers more. In the organ itself, there is an expansion of the urinary elements (calyx-pelvic system), the ureters expand. The capacity of the urinary tract is increased to 50-70 ml (per kidney).


Kidney congestion can be caused by urinary oversaturation

The kidney and ureter, overloaded with urine (congestion and increased pressure), find themselves in a situation favorable for exacerbation of chronic pyelonephritis. In this case, primary pyelonephritis can also form.

These processes are observed in pregnant women with kidney disease from the 3rd to the 8th month (before the prolapse of the fetus).

From the 8th month, there has been an improvement in the condition of the pregnant woman. Finally, the kidneys return to normal, as a rule, by the 4th month after childbirth.

Factors provoking exacerbation

An essential role is played by the condition of the ligamentous apparatus of the kidneys, as well as the condition of the fat capsule.

If pregnancy is combined with low body weight, the likelihood of an exacerbation of pyelonephritis increases significantly. Try to adjust your first trimester nutrition accordingly.

Of course, the current state of the kidneys plays a role, as well as the severity of vesicoureteral reflux (i.e., urinary reflux).

Often, an exacerbation of pyelonephritis is associated with peak hormone levels, which is quite typical for pregnant women.

In this case, the problem is not so much in the dysfunction of the renal valve apparatus, but in the effect of estrogen and progesterone on some types of receptors. This situation can be suspected in time and the gynecologist-endocrinologist can help to correct it.

Even in the absence of a focus of chronic infection in the body (or with its relative passivity), in pregnant women, the infection often rises from the bladder, or spreads through the lymphatic or bloodstream.

In the first case, this is facilitated by stagnation in the ureters and the kidneys themselves, in the second - by a drop in immunity, which is not uncommon during pregnancy.

As a result, an exacerbation of chronic pyelonephritis develops, or an acute renal infection (acute

The causative agent is most often Escherichia coli, Proteus, Enterococcus, Staphylococcus aureus, Candida.

What is the danger of a disease during pregnancy

Early toxicosis can be a consequence of exacerbation of chronic pyelonephritis

An exacerbation of pyelonephritis leads to early gestosis (toxicosis), with extensive symptoms: pressure increases, edema develops, and there may be convulsions. There is a loss of protein in the urine.

Gestosis, as you know, is still the main cause of maternal mortality.

Against the background of an exacerbation, miscarriages and premature births occur quite often. The placenta can flake off prematurely, which also leads to miscarriage.

With severe immunodeficiency of the mother, the fetus can be infected with a pathogen that triggers an exacerbation of pyelonephritis. In this case, the child may develop abnormally, since his tissues experience hypoxia (lack of oxygen and nutrients).

After exacerbation during pregnancy, pyelonephritis in the postpartum period is much worse, which affects the quality of life of the mother.

Severe complications of the disease: sepsis (septicemia, septicopyemia), toxic (bacterial) shock. Given the high mortality of these conditions, pregnant women with pyelonephritis are always considered a high-risk group.

If you have (or have had, at least once) pyelonephritis or any other kidney disease - be sure to inform your gynecologist about it.

Symptoms of chronic pyelonephritis in expectant mothers

The chronic form can proceed for a rather long time in the absence of an extensive clinic. More precisely - some soreness in the lower back is present, as well as a slight increase in body temperature, however, the patient often does not attach due importance to this.

This is either due to the abundance of "special effects" characteristic of pregnancy as a condition (vomiting, bloating, taste perversion, irritability, etc.), or due to the habit of constant pain from the kidneys (with untreated or severe pyelonephritis, urolithiasis, etc.).

Signs in the photo

General weakness Nausea and vomiting Change in the color and odor of urine Increased body temperature

Weakness gradually increases, the color of urine may change. All this, by the way, can also be attributed by the patient to the pregnancy itself, especially if the pregnancy is the first. Low back pain appears, which can be both dull and sharp (stabbing). The pain is usually worse when the body bends forward.


At the first signs of exacerbation of chronic pyelonephritis in a pregnant woman, you must call a doctor

Exacerbation of the chronic process is accompanied by the following phenomena:

  • The body temperature rises to 39-40 0С, chills appear;
  • The pregnant woman begins to vomit up to vomiting, appetite decreases;
  • Urine may have a strong and unpleasant odor. The color may turn reddish;
  • Great general weakness.
  • high body temperature (38-40 degrees);

Doctors differentiate exacerbation with acute appendicitis, colic, cholecystitis, as well as with nephropathy and manifestations. It will not work out on its own, therefore, with the above symptoms, the pregnant woman is hospitalized.

During an exacerbation of chronic pyelonephritis (even if it is suspected), the pregnant woman must be unconditionally hospitalized.

Risk levels

There are 3 levels of risk to prevent maternal mortality. The first includes uncomplicated primary pyelonephritis during pregnancy. In this case, there are no special contraindications for pregnancy.

If a woman had chronic pyelonephritis before pregnancy, she already falls into the second risk group.

The first and second groups are additionally monitored by a nephrologist or therapist, and most of these pregnancies are resolved safely.

If pyelonephritis is combined in a pregnant woman with hypertension, anemia, or there is only one kidney, pregnancy is contraindicated.

Of course, you can leave the fruit, but you will have to sign a lot of necessary documents and listen to several specialized specialists. The risk to your life in this case is quite real, and the health of the fetus is at risk up to (and during) the birth.

Treatment of chronic pyelonephritis in pregnant women


One aspect of treatment is detoxification therapy

Pyelonephritis is treated according to strict principles of therapy, i.e. the pathogen is sown, an antibiotic is selected for it, taking into account the contraindications and side effects of the drug. It must be understood that the benefit / risk ratio can go quite far beyond the boundaries of the instructions for the drugs.

The need to prescribe this or that drug is due to concern for the safety of the mother and fetus. Since life is the highest value, the appointment of non-indicated drugs during an exacerbation of chronic pyelonephritis in pregnant women is allowed.

In addition to antibiotics, vitamins, mineral waters (Essentuki No. 20), antispasmodics and diuretics, physiotherapy and exercise are prescribed.

The pregnant woman undergoes detoxification therapy - dripping rheopolyglucin, protein solutions, hemodesis. To prevent fetal developmental disorders, trental is prescribed (reduces tissue hypoxia).

If the treatment is not effective enough, ureteral catheterization can be performed for a stable passage of urine.

An exception may be very strict obstetric indications, for example, the discrepancy between the linear parameters of the small pelvis and the head of the child.

If pyelonephritis is accompanied by severe toxicosis, early delivery is performed.

The woman in labor is observed in the hospital for 10 days, after which she is discharged from the hospital home, under the supervision of a nephrologist (urologist).


If you adhere to simple dietary rules, the risk of exacerbations can be reduced

It is necessary to consume a lot of liquid (more than 2 liters per day), fried, spicy and fatty foods are excluded. In the absence of associated pathologies from the digestive system, it is advisable to consume a lot of vegetables and fruits every day.

Meat, fish and mushroom broths are contraindicated (meat, fish and mushrooms can be added to vegetables and cereals), since extractives can provoke an exacerbation of pyelonephritis.

To reduce the load on the kidneys, it is necessary to reduce the consumption of table salt (total consumption per day up to 8 g).

When the first signs of exacerbation appear, strict bed rest is shown. In the period of remission, on the contrary, it is desirable to be quite active, since this improves the outflow of urine.

Compliance with these rules, plus timely consultations of specialized specialists, significantly reduce the risk of exacerbation of chronic pyelonephritis during pregnancy. At the first signs of an acute process (fever, weakness, back pain), call a doctor immediately.

Video: Pyelonephritis in pregnant women