Primary pyelonephritis gives a more pronounced clinical picture than secondary. The following symptoms may indicate an exacerbation of chronic pyelonephritis:
- increase in body temperature to high values, sometimes up to 39 degrees,
- the appearance of pain in the lower back area both on one and on both sides,
- the occurrence of dysuric phenomena, - deterioration of the general well-being of the patient,
- lack of appetite,
- the occurrence of headaches,
- abdominal pain, vomiting and nausea more often occurs in childhood than in adult patients.
The patient's appearance changes somewhat. He can notice these changes independently, or the doctor will pay attention to them during the examination. The face becomes somewhat puffy, there may be puffiness of the eyelids. The covers are pale, bags under the eyes are not uncommon, they are especially noticeable after sleep.
The difficulty of diagnosing chronic pyelonephritis is due to the variety of clinical variants of the disease and its possible latent course.
In the general analysis of urine in chronic pyelonephritis, leukocyturia, proteinuria, and cylindruria are detected. The study of urine by the method of Addis-
Kakovsky is characterized by the predominance of white blood cells over other elements of the urinary sediment. Bacteriological urine culture contributes to the detection of bacteriuria, identification of pathogens of chronic pyelonephritis and their sensitivity to antimicrobial drugs. To assess the functional state of the kidneys, Zimnitsky and Rehberg tests are used, as well as a biochemical study of blood and urine. In the blood of chronic pyelonephritis, hypochromic anemia, accelerated ESR, and neutrophilic leukocytosis are detected.
The degree of impairment of renal function is specified using the cystochromoscopy, excretory and retrograde urography, neprezentare. A decrease in the size of the kidneys and structural changes in the renal tissue are detected by ultrasound of the kidneys, CT, MRI. Instrumental methods in chronic pyelonephritis objectively indicate a decrease in the size of the kidneys, deformation of the cup-pelvic structures, and a decrease in the secretory function of the kidneys.
Treatment of chronic pyelonephritis includes a gentle regime, diet and drug therapy. Patients should avoid hypothermia and colds. Any infectious diseases that occur against the background of pyelonephritis require adequate therapy and monitoring of urine tests.
Medical therapy may be effective only under the condition of ensuring a smooth flow of urine. Of the drugs, antibacterial agents (antibiotics, sulfonamides, uroseptics) are usually used. Antimicrobial treatment is prescribed taking into account the sensitivity of the microorganisms that caused the inflammation. In the case of chronic pyelonephritis, treatment is long-term, usually a combination of antibacterial drugs with a different mechanism of action is used. Antibacterial treatment should be continued until complete elimination of leukocyturia and sterilization of urine.
When the exacerbation subsides, anti-relapse treatment is carried out, which consists in a long, multi-month use of minimum doses of antimicrobial agents with periodic changes of drugs. Along with medical treatment, herbal medicine is important. A good effect is observed when using decoctions and infusions of various plants that have a diuretic, anti-inflammatory and antibacterial effect. Juniper berries, horsetail grass, bearberry leaf, kidney tea are usually used.