Symptoms of pyelonephritis - these are the clinical manifestations of the disease, on the basis of which it can be concluded about the occurrence of this disease. In cases with different forms and types of the disease, the symptoms may differ significantly, so it is important to understand what each specific symptom indicates.
Common signs of the disease
In the clinic of the classic course of acute pyelonephritis or the exacerbation of its chronic form, there are three main symptomatic groups: intoxication symptoms, soreness and impaired renal functionality. In each case of acute pyelonephritis, all these groups of symptoms will be pronounced.
The intoxication process in pyelonephritis is manifested by poisoning the body with various poisons released during infection of the renal tissue. Symptoms of intoxication are expressed in headache, the occurrence of severe weakness, pain in the joints and muscle tissue, lack of appetite, nausea and vomiting, thirst, dryness in the mouth. A clear manifestation of intoxication is the occurrence of chills, followed by a sharp jump in body temperature to 39-40 degrees and profuse sweating. Intoxication manifestations fall into the category of general characteristics of the disease, in addition to which local manifestations also arise - pain and impaired renal functionality.
Pain in acute pyelonephritis is usually localized in the lumbar region of the affected kidney. Also, pain can flow into the left or right hypochondrium, groin area and genitals. Soreness can be characterized as a constant presence, and paroxysmal symptoms. Pain in the acute form of the disease is often acute, but dull pains are also present quite often. Increased pain is observed when coughing, at night, in the case of movement with that leg, from the side of which the kidney is damaged.
Morbidity with pyelonephritis can occur simultaneously with hyperthermia or a couple of days after the temperature stabilizes. In rare cases, the pain is replaced by a feeling of heaviness in the lower back. Unsharp pain syndrome, as a rule, is observed in patients with diabetes, patients with mental disorders or multiple sclerosis.
Urine excretion with turbidity is the main sign that the kidney function is impaired. Secondary pyelonephritis in this case, as a rule, is accompanied by comorbidities of a urological nature.
Due to the fact that in most cases of pyelonephritis or acute exacerbation of the patient, there is also a parallel acute cystitis, the pyelonephritis clinic may be supplemented with some nonspecific symptoms:
- pain and pain during urination;
- pollakiuria (frequent urination);
- hematuria (blood impurities in the urine);
- nocturia (excessive and frequent urination at night).
In this case, the daily rate of urine may become lower due to excessive sweating and loss of fluid in its process.
Manifestations of acute pyelonephritis
Acute pyelonephritis is a nonspecific renal pathology resulting from a bacterial attack. Bacterial agents enter the kidneys through the urinary tract or blood, thus being subdivided into exogenous and endogenous. Interstitial renal tissues and the renal pelvis system are subjected to pathological changes. Most often, children and women are susceptible to acute pyelonephritis, which is explained by the physiological and anatomical structure of their organisms. Men suffer from the disease less often, the duration of the pathology in them is largely determined by the course of the disease that caused the occurrence of pyelonephritis, for example, prostate adenoma.
The acute course of pyelonephritis is divided into obstructive and non-obstructive. With non-obstructive pyelonephritis, the general symptoms of infection penetration into the body prevail. In the case of obstructive pyelonephritis, local symptoms are more pronounced.
Acute non-obstructive pyelonephritis develops in a patient at high speed - in 3-24 hours. In this case, the patient feels pronounced weakness, malaise and chills. Hyperthermia often reaches 40 degrees, pronounced headaches annoy, tachycardia occurs. Sometimes there are violations in the gastrointestinal tract - constipation, gas, diarrhea. From the manifestations of local symptoms in non-obstructive pyelonephritis lumbar pains are observed, spreading to the femoral zone or to the back and abdomen. Soreness can be either intensely pronounced or dull and aching. Regarding the process of urination, it can be said that it is very rarely disturbed, however, the amount of daily urine output often decreases many times over. This process is due to high perspiration due to hyperthermia of the body. The duration of the acute manifestation of symptoms in non-obstructive pyelonephritis directly depends on the speed of diagnosis and the start of therapeutic treatment. As a rule, a couple of days after the start of treatment, the severity of symptoms is significantly reduced.
Acute obstructive pyelonephritis is always at the start manifested renal colic. Accompany colic fever, chills, shooting pain in the head. Often diarrhea and vomiting can be added to such acute symptoms, the patient is thirsty, the body temperature rises to critical levels in the shortest possible time. At the same time there is a strong sweating, due to which the temperature of the body quickly decreases. After lowering the temperature, the patient feels better. All these processes can occur within 1 day, which hides the danger - after normalization of temperature and well-being, the patient relaxes and is in no hurry to seek medical help, which is simply necessary to prevent repeated recurrences of such attacks. The duration of the symptoms of acute obstructive pyelonephritis as well as in the case of non-obstructive, directly depends on the rate of onset of treatment of the disease.
Acute pyelonephritis has several clinical forms:
- acute, characterized by severity of general condition, high fever, chills;
- acute, with severe local symptoms and chills;
- focal (subacute), with severe local symptoms and erased common;
- latent, with a small number of poorly pronounced local manifestations.
Also, the course of acute pyelonephritis is characterized by two stages - serous and purulent. If in time not to stop the initial serous stage of the disease, then it will turn into purulent, expressed by anastomotic nephritis or carbuncle of the kidney. Background for this development of pyelonephritis is usually urolithiasis.
The clinical course of the disease is usually characterized by a kind of staging. Each stage in its characteristics will correspond to pathological changes that occur in the kidneys.
At the initial stage of pyelonephritis, serous inflammation occurs, accompanied by a slight increase in the kidneys, their slight stress, and perivascular infiltration. With timely medical care, the development of pathology at this stage is easily stopped by classical therapy. Therapy can lead to a reversal of the inflammatory process and complete recovery of the patient. If the treatment was not started in time, the pathology gets an impetus to its own development and transition to the purulent-destructive stage.
The purulent-destructive stage of pyelonephritis is characterized by the occurrence of apostematosis. Apostematic pyelonephritis is a disease characterized by the occurrence of numerous small pustules in the cortical renal substance. If there is no therapy, the abscesses merge into a single large inflammatory focus, called the carbuncle of the kidney. Such an education in size reaches 2 centimeters and can be both single and numerous. Carbuncles and pustules gradually lead to a renal abscess, as a result of which the contents of the abscesses begin to pour out into perirenal fiber. Timely treatment helps to heal the infiltration, but it leads to the formation of scars on the surface of the renal tissue. The treatment time is very individual and depends on the severity of symptoms, as well as the extent of infection and literacy and completeness of therapy.
Manifestations of chronic pyelonephritis
Chronic pyelonephritis in women is very difficult to diagnose, because it often does not manifest itself. It is important to pay attention to indirect symptoms, indicating the pathological process and its exacerbation.
Among the main symptoms of chronic pyelonephritis include:
- discomfort in the lower back;
- general malaise;
- rare cases of nausea;
- changes in urination;
- sharp changes in body temperature.
Quite rarely, burning sensation directly in the area of the kidney can join such indirect symptoms. If the temperature of the body sometimes fluctuates, it is important to pay attention to this, since this symptom clearly indicates irreversible inflammatory renal processes.
In chronic pyelonephritis, there are 3 stages of the pathology. The first stage is characterized by leukocyte infiltration of interstitial brain tissue and atrophy of the collecting ducts. It also has the intactness of the glomeruli. In the second stage, the process of inflammation leads to cicatricial and sclerotic lesions of the canaliculi and interstitium, with the result that the terminal parts of the nephrons die and the tubules are compressed. In parallel with this process, desolation and hyalinization of the glomeruli, obliteration and vasoconstriction occur. In the third stage, the scar tissue replaces the kidney, the kidney shrinks, shrinks and becomes covered with tuberosity.
The inflammatory process according to the degree of its own activity divides the course of pyelonephritis into phases.
The phases of chronic pyelonephritis include:
- active inflammation phase;
- latent phase;
- phase of clinical health or remission.
During therapy, the active phase of inflammation is replaced by the latent one, and that, in turn, can lead to both remission (recovery) and the resumption of the active phase with inadequate or absent treatment. In the remission phase of clinical symptoms of pyelonephritis is not even in the results of urine analysis.
Clinic of disease development can divide chronic pyelonephritis into latent or erased, recurrent, hypertensive, anemic and azotemic.
In the latent form of chronic pyelonephritis, the clinical manifestations are very scarce. Among the main symptoms of this condition are low-grade fever, high fatigue, headache. Usually there is no dysuria in the latent form, and Pasternatsky syndrome can produce a weak positive result. Among the obvious symptoms may be a slight proteinuria, bacteriuria, intermittent leukocyturia. The concentration of the kidneys is disturbed and manifests itself in polyuria and hypostenuria. Some patients may suffer from mild hypertension or anemia.
In the recurrent form of chronic pyelonephritis has a wave-like phase of the flow, in which the exacerbations are often replaced by a decrease in the inflammatory process. Among the main clinical manifestations, there are aching pains and heaviness in the lumbar region, intermittent fever, and dysuria. In the acute phase of chronic pyelonephritis, all the symptoms of an acute illness are present. If the recurrent form progresses, then an anemic or hypertensive syndrome may occur against its background. Under laboratory conditions with recurrent form of chronic pyelonephritis, one can see persistent leukocyturia, proteinuria, bacteriuria, cylindruria, and occasionally hematuria.
Latent and recurrent forms of chronic pyelonephritis are characteristic of all patients, regardless of age and gender. Further forms in children practically do not occur, since even the first 2, with incorrect or absent treatment, give a very strong load to the fragile organism.
Hypertensive form of chronic pyelonephritis is characterized by increased blood pressure. Such hypertension is accompanied by dizziness and hypertensive crises, heart pain, shortness of breath. Hypertension is malignant, urinary syndrome is intermittent or unexpressed.
In anemic form, hypochromic anemia develops. This form of chronic pyelonephritis is not accompanied by hypertension, and urinary syndrome with it is very weak. Azotemic is understood to mean the combined form of the disease with the symptoms of common chronic pyelonephritis and test data, which are characteristic of the most common forms of the disease.
Symptoms of the disease in pregnant women and newborns
More than 10% of all patients with diagnosed pyelonephritis are pregnant women. Primary pyelonephritis in this condition occurs for the first time during the period of an interesting situation, and the secondary one becomes aggravated against the background of the growing uterus and its pressure on the surrounding organs. The uterus with increasing squeezes the ureters and kidneys, the movement of urine becomes difficult. Also, the symptoms of pregnant pyelonephritis are often caused by hormonal changes in the woman's body.
The aggravated form of the disease in the body of a pregnant woman is usually manifested by high body temperature, increased heart rate, signs of intoxication, and cutting during urination. Painful sensations, basically, annoy at night. However, pregnant pyelonephritis is often asymptomatic, and patients will learn about it only from the results of tests.
Pyelonephritis in infants is an inflammatory process in the kidneys of a child who feeds on mother's milk. The disease is provoked by pathogenic microbes. More often than not, boys suffer from girls, the disease usually appears at the age of 4-5 months and is associated with the transition of the child to artificial feeding. Newborns suffer from pyelonephritis in only 1-3% of cases of all childhood diseases, with preterm babies most often affected by this pathology.
The symptomatology of the disease in newborns and infants differs both among themselves and in comparison with the similar course of the disease in adults.
Infants usually experience symptoms such as:
- breast rejection (lack of appetite);
- frequent regurgitation, vomiting;
- unpleasant smell of urine, painful urination, weeping, small volumes of urine;
- loose stools;
- high drowsiness;
- high weight loss.
Regarding newborns, it is worth noting that the symptoms of pyelonephritis in them are non-specific due to the circulation of pathogenic microorganisms in the baby’s blood.
Symptoms of neonatal disease include:
- critically low or critically high body temperature;
- severe jaundice;
- breast failure;
- vomiting and repeated regurgitation;
- developmental delay.
A characteristic symptom for newborn boys is also hyponatremia and hyperkalemia, however, sometimes these conditions are characteristic of pyelonephritis and for girls.
Blood tests demonstrate such changes in pyelonephritis in a child as neutrophilia, anemia with protein deficiency and iron deficiency, accelerated ESR.
A characteristic sign of the exacerbation of chronic pyelonephritis or the occurrence of acute in a child will be leukocyturia in urine tests with active leukocytes in the sediment. In parallel, bacteriuria occurs. In order to clarify the etiology of the disease, urine sap is taken for children, after which the flora and antibiotics are determined, to which it will be sensitive. The first days of the disease are characterized by the occurrence of microhematuria and gross hematuria, moderate proteinuria.
The test carried out by Zemnitsky in a child often does not demonstrate pathology in the kidney function; this becomes possible only with a large-scale quantitative lesion of the tubules. Clearance tests are conducted to understand the level of reduction of reabsorption and filtration. Be sure to conduct tests for the study of urea and the level of creatinine in the blood.
When to ask for help
All women who detect the signs and symptoms of pyelonephritis should be examined as soon as possible by a gynecologist in order to identify the site of infection associated with the disease. If a woman suffers from cystitis or diseases of the sexual sphere, curing pyelonephritis of any stage will be much more difficult, which will entail its transition to the chronic form.
At the same time, long therapy with antibacterial drugs leads to a loss of sensitivity of the pathogenic flora to them, which eliminates the entire effect of the treatment.
Appeal for help with pyelonephritis in men should also occur immediately after the first symptoms are detected. At the same time, men are examined by urologists, because usually the age-related male pyelonephritis is associated with congestion of the urinary tract, which is provoked by diseases of the urogenital area - prostate adenoma, prostatitis, and others. The cause of stagnation must be treated initially, in parallel with the treatment of pyelonephritis itself, because if not to eliminate the stagnant processes, the inflammation will return again.
With the symptoms of pyelonephritis in children, medical care is needed in the early stages of the disease. At an early age, a common cause of this disease is congenital reflux, due to which urine is thrown into the kidneys from the bladder and ureters. This etiology of the disease allows the use of both conservative therapy and surgery in particularly difficult cases.