Pyelonephritis is an infectious inflammation of the renal pelvis, calyces and renal parenchyma caused directly by bacteria. The disease is more common in women, with a female:male ratio of about 10:1. It is especially prevalent in women of marriageable age, young infants and older women. The disease mostly affects one kidney, but can also involve both kidneys.
I. Etiology
1. Causing bacteria
The most common causative agent of pyelonephritis is Gram-negative bacilli, especially Escherichia coli, which accounts for 60-90% of cases. About 5-10% of pyelonephritis is caused by Gram-positive cocci, mostly in pyelonephritis with urinary stones, and Staphylococcus aureus is common in hematogenous pyelonephritis due to sepsis.
2. Virulence factors
In the pathogenesis of pyelonephritis, bacterial virulence factors play an important role.
3. Ex vivo differences in pathogenic bacteria.
II. Main symptoms
1.Acute pyelonephritis
(1) Urinary symptoms: there are often symptoms of urinary tract irritation such as urinary frequency, urinary urgency, and urinary pain, which may be accompanied by lumbago, pressure pain or percussion pain in the kidney area, and pressure pain in the upper abdomen.
(2) Systemic infection symptoms: mostly acute onset, chills, high fever (temperature can be 39`C or more), headache, nausea, vomiting, loss of appetite, even abdominal pain, diarrhea, if the high fever persists, it often indicates the coexistence of urinary tract obstruction, renal abscess or sepsis.
(3) Urine changes: cloudy urine appearance, pus urine or hematuria can be seen.
2, chronic pyelonephritis
(1) urinary tract infection manifestations: most patients have recurrent urinary tract irritation symptoms, some patients have intermittent asymptomatic bacteriuria, lower urinary tract symptoms such as urinary frequency and discomfort in urination, and mild lumbar and abdominal discomfort.
(2) Symptoms of chronic interstitial nephritis: manifested as symptoms of decreased renal tubular concentration such as polyuria and nocturia, and such patients are prone to dehydration.
III. Use of guided medication
Before using antimicrobial drugs, it is best to make clean middle urine bacterial culture and routine urine examination to determine the type of bacteria as early as possible, which helps to select antimicrobial drugs. In the selection of antibacterial drugs for pyelonephritis should take into account: (1) good antibacterial effect, sensitive to pathogenic bacteria, not easy to produce resistance (2) drugs in kidney tissue, urine and blood have a high concentration (3) small adverse reactions, no toxicity to the kidney (4) severe patients should be combined with drugs (5) to have a sufficient course of treatment, generally not less than 14 days.
IV. Dietary guidance
1.Give liquid or semi-liquid diet according to the systemic condition when fever is present, and give ordinary diet when there are no obvious symptoms.
2. Know that patients drink more water, up to 1 hot water bottle a day, to ensure that the daily urine volume is not less than 2000nl.
V. Rest and activity
Patients with pyelonephritis with fever, significant urinary tract irritation or hematuria can get up and move around after symptoms are significantly reduced, and generally rest for 7~10 days and resume work after symptoms disappear completely.
VI. Rehabilitation guidance
1. Drink more water and urinate more often.
2. Pay attention to the cleanliness of the perineum and change underwear regularly.
3. Avoid using urinary tract equipment as much as possible.
4. Avoid straining, adhere to physical exercise, and increase body resistance.