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Introduction Note: 1. Acute exacerbation of chronic pyelonephritis should be bed rest, recovery can gradually increase activity. 2. In time to urinate. Especially after sex, female patients should be timely urination, to rush to enter the urethra and bladder of bacteria. 3. More water. 4. Note that sexual health. 5. Prescribed drug adherence is critical to the treatment of chronic pyelonephritis things. Classification of Diseases, Division of Nephrology symptoms of systemic poisoning symptoms and signs: chills, fever, fatigue, loss of appetite. Local symptoms: backache, low back pain and spinal rib angle knocking pain. irritative bladder symptoms: frequent urination, urgency, dysuria and urination problems. History of urinary tract infections and more than six months, antibiotic treatment ineffective. Disease causes some patients have predisposing factors exist, such as urinary tract obstruction, abnormalities, kidney and bladder prolapse - reflux and so on. Pathophysiology 1. Visible renal atrophy, atrophy determined by disease severity and uniformity. Uneven surface area of renal scarring, renal capsule
The pathology of chronic pyelonephritis pale and difficult to peel, vertical and horizontal section in the kidney, these are the causes of chronic pyelonephritis, mild lesions were most of the area still retains the normal cortex and medulla, while severe cases, inflammation and extensive fibrosis to destroy the normal structure of the kidney, renal pelvis mucos


a pale and fibrosis. 2. Microscopic examination revealed a large number of renal parenchyma infiltration of plasma cells and lymphocytes, showed varying degrees of tubular degeneration, tubular part of the expansion, the secretion contains proteins, involvement of glomerular fibrosis and significant occurrence of hyaline change, often thickening of arteries and arterioles, in addition to scar formation and chronic inflammation outside areas, but also shows patchy acute inflammatory lesions, thus making expansion calyceal renal parenchymal scar above become less typical . Because of chronic bacterial pyelonephritis and many other non-infectious interstitial nephritis very similar pathological changes, so can not determine the histological cause of chronic pyelonephritis. Routine autopsy found that the pathological changes of chronic pyelonephritis incidence rate of 10% to 15%. There is no doubt that the real cause of chronic pyelonephritis to be much lower than the incidence of this figure. Check the performance of diagnostic tests show IVP pelvis, calyceal distortion, narrowing, renal morphology (B-, CT, etc.) show irregular renal shadow, and even reduced; have sustained damage to renal tubular function, such as urine osmolality lower urinary retinol binding protein, 2 microglobulin increased. Standard imaging studies confirmed that one of the following can be diagnosed (1) See IVP in renal pelvis, calyx deformation and narrow. (2) kidney shape uneven, ranging from the size of the two kidneys. Differential diagnosis of kidney, bladder irritation, urinary tuberculosis was, Mycobacterium tuberculosis culture positive, common antibiotic treatment ineffective. No lower urinary tract infection and renal area percussion pain symptoms, no white tube. Chronic glomerulonephritis was no significant bladder irritation, bacteria-negative, WBC more obvious, urine protein generally greater than 2g/24h, mainly glomerular dysfunction. Treatment care:
Chronic pyelonephritis 1. By kidney disease care and routine care, there were at fever heat routine nursing care. 2. Urine, urine sediment to find bacteria, fungi cultivation should be left in the morning urine. Prepuce of the female and male, should first clean the vulva urethra. Clean midstream urine collection by the implementation of Chapter VIII of Title III. All urine samples collected, should be immediately censored. Treatment: drug selection: as far as possible the results of susceptibility testing with clinical efficacy in the selection of sensitive antibiotics. treatment: the treatment of acute exacerbation of acute pyelonephritis with female patients in the clinical cure after 1 day before the monthly menstrual cramps or cramps, immediately use of antibiotics 7 ~ 10d; such as attack and sexual intercourse is related to sexual intercourse can be back empty urine, taking effective antimicrobial agents 1 ~ 3d, men with early drug use fixed monthly total of 3 to 6 months, or at night after the acute phase with the original dose of 1 1 / 2 to 1 / 3, continued Treatment of 3 to 6 months. lesions of chronic infections, such as gynecological disorders, chronic colitis, gum abscess, chronic tonsillitis, otitis media, sinusitis, or urinary tract obstruction should be congenital abnormalities, and treatment. Have diabetes, uric acid nephropathy should actively control blood sugar, uric acid, the right ureter due to compression by ovarian varicose veins, varicose veins should be ligated. Chinese medicine: the acute phase can detoxify, on a rousing mainly chronic, kidney Yin Yang Shen Qi. Select heat treatment of focal disease secrete inflammatory medicine such as Silver Flower Tablets and other drugs for treatment, while upholding the rule of traditional Chinese medicine containing Loranthaceae consolidation therapy, can improve the chronic recurrent pyelonephritis risk. Cure criteria: 1. Clinical cure the symptoms disappeared, the withdrawal 72h, for every 2 ~ 3d urine and bacterial cultures, 3 consecutive negative. 2. Recovered after clinical cure, bacterial culture of urine and 1 to 2 times the monthly re, consecutive six months were negative. Drug treatment: (1) treatment principles: 1) selection of sensitive and less toxic bacteria, and in the renal parenchyma and urine have a higher concentration of antibiotics. 2) a longer course of treatment (4 weeks or 6 weeks) to achieve the objective of complete removal of bacteria. 3) If you can not remove bacteria and recurrent acute urinary tract infection, length of treatment with low doses of antimicrobial therapy, medication at least 1 year. 4) The occurrence of uremia, they need to pay attention to protection of renal function to avoid accumulation of toxic drugs, but also well inhibit bacterial growth. (2) the drug of choice: Light available cotrimoxazole, fluoroquinolones or -lactamase inhibitor plus a semi-synthetic broad-spectrum penicillin oral, are required to re-combination therapy and intravenous drug use, such as piperacillin plus triazole Pakistan Tanzania (tazobactam) or imine Division buna (imipenem / cilastatinsodium) (use with the twenty-seventh chapter II, the treatment of acute pyelonephritis). More difficult to treat chronic pyelonephritis acute pyelonephritis by the change from, but if the long-unhealed if chronic pyelonephritis, recurrent, will eventually lead to chronic renal failure, that uremia. In turn, patients who had uremia, such as secondary to renal infection, has become a factor in increasing uremia. Clinically, this situation is often seen, once the kidney infection was controlled, tend to reduce uremic symptoms, called reversible factors. If uremic patients with renal infection, treatment very difficult, refractory chronic pyelonephritis combined with uremia following five reasons: uremic patients, renal blood flow reduction, antimicrobial agents in the renal tissue to achieve effective concentration required for a long time, so the bacteria are prone to drug resistance. Renal Uremia often pathogenic infections in the hospital sick, and thus more resistant strains. the use of antimicrobial drugs contradictions, such as: uremia, in order to avoid systemic drug toxicity, often reducing the use of antimicrobial agents, but after reduction, the concentration of antibiotics in the kidney level, difficult to achieve sterilization, it is poor efficacy. uremia, there are many antibacterial drugs with renal toxicity to be used with caution, or disabled, for example: polymyxin, polymyxin, kanamycin, Streptomyces, vancomycin and other renal toxic to be used with caution. Tetracycline medicines will increase the azotemia, furan mouth once pyridine used in renal failure can lead to paralysis and other symptoms of toxicity, it is appropriate to use in uremia. uremic patients because of drug excretion in patients with hypothyroidism, and if a long course of treatment, easy accumulation of poisoning. Some people eager to heal, long-term medication continuously, it will not only fail to end, and led to the invasion of resistant bacteria, or even more than 2 kinds of bacteria causing infection, but to the greater difficulty in treatment. In conclusion, patients with pyelonephritis acute pyelonephritis should be the time period should be effectively controlled, if unfortunate turn into chronic pyelonephritis, should prevent transformed into uremia. Safe use of drugs to prevent renal damage, such as: streptomycin, gentamicin, ionic contrast agent. No special dietary requirements. Chronic pyelonephritis into renal failure, renal failure in accordance with treatment. Clinical manifestations of clinical manifestations of chronic pyelonephritis - chronic pyelonephritis topic
CT of chronic pyelonephritis in the past that the majority of chronic pyelonephritis acute pyelonephritis by the inadequate treatment of recurrent Erzhi. In recent years, the relationship between a new understanding that the relationship between the two is not as important as previously mentioned, the diagnostic criteria of chronic pyelonephritis has been the amendment. According to the literature, this disease accounted for 7% of pyelonephritis 20%, only half of the patients with acute episode of pyelonephritis. Complex clinical manifestations of the disease, symptoms multiport. The main performance is true of bacteria in urine, urine white blood cells and proteins, only a small amount of bacteria in urine can be continuous or intermittent. Many patients with recurrent urinary tract irritation. Clinical manifestations of chronic pyelonephritis: Symptoms: children (and occasionally adults) can occur in patients with chronic bacterial acute pyelonephritis. Found only in acute exacerbation of fever, no acute attack patients may asymptomatic. When the advanced stage of chronic pyelonephritis and involving both kidneys, can have high blood pressure, anemia, and azotemia related symptoms. Laboratory tests: in the absence of acute infection cases attack or azotemia, blood tests are usually normal. Urinalysis results depend on whether there is active infection and the severity of renal damage, only in some cases can be found pyuria and bacteriuria. Significant proteinuria means a serious condition, disease involving the glomeruli. If there is bacteriuria, urine culture is positive, the condition of patients at different stages of serum creatinine and blood urea nitrogen can be normal or elevated. X-ray examination: abdominal plain film shows one or both kidneys shrink, and not rules. Sometimes visible urinary tract stones. Urography can be found in the characteristic of chronic pyelonephritis performance, such as the expansion of the renal pelvis, as well as the surface scarring or atrophy of renal parenchyma, renal parenchymal distortion, poor and developing imaging contrast agents delay. In unilateral atrophic pyelonephritis, compensatory expansion of the contralateral kidney. If vesicoureteral reflux, ureteral expansion appears. Retrograde urography also seen a similar performance, retrograde urethrography can be found in the bladder VUR, especially children, were more common. Chronic pyelonephritis diet
Chronic pyelonephritis carbonated mineral water springs of treating chronic pyelonephritis. 500 ml mineral water, carbonated spring prescribed regimens of tea, a few times a day to drink a total of 500 ml of the mineral water. Juice drink urine attending the three missing, astringent feeling hot pain. Prescription watermelon grapes 25O grams 200 grams 250 overcoming lotus watermelon skin Jiao Zhi, grapes, Xianou also Jiao Zhi, three juice evenly mixed drink. Core to be painful urination attending poor Tom. 100 grams of corncob prescription required 250 grams of corn a little cinnamon Directions to the residue decoction three things, drinking dollars. Common chronic pyelonephritis measures: 1. Note the cleanliness of the vulva and urethra. To Qinhuan underwear, especially in women, menstrual period, pregnancy, or decreased body resistance, such as not pay attention to genital hygiene, bacteria can enter the bladder through the urethra by the bladder, ureteral reflux into the renal pelvis and the power and then invaded and real, the formation of urinary tract infection. 2. In the diet to be high-calorie, high vitamin, semi-liquid or easy to digest ordinary food. To the water, the daily intake of not less than 3000 ml, to increase the urine output will help flush the urinary tract, promoting bacteria, the discharge of toxins and inflammatory secretions. 3. Enhance physical exercise improve the body's resistance to disease. Attention to rest, avoid fatigue and constipation. 4. Female patients after the acute stage of cure, within a year should pay attention to contraception. 5. Women were prohibited bath, so bath water upstream into the bladder, causing infection. Standing of the drugs: Constantine furan 0.1 g, orally, 3 to 4 times daily, for better urinary tract infection. PPA 0.5-0.75 grams, 3 to 4 times a day orally. Vitamin C1 g, orally, 3 times a day, can enhance the role of furan Constantine. (Vitamin C can make urine acidification, furans Constantine antibacterial effect in the enhanced acidic urine). Complications in patients with chronic pyelonephritis prone to high blood pressure and kidney stones, especially bacteremia infection stones prompted some bacterial pyelonephritis in early childhood fat
Anatomical development of the adult kidney of chronic renal insufficiency factors: treatment is not complete recurrent or persistent infection; renal hypoplasia or deformity; progressive immune damage occurred; hypertensive renal damage; serious vesicoureteral reflux on kidney damage; infection of the kidney stones occur in particular infection caused by the urease-producing bacteria were Chinese diet side 1. Carp 1, weighing about 250 grams, abdominal viscera to wash, 10 grams of minced garlic into a large, clean and outsourcing white paper, soaked with water, add the cooked bran. Fresh fish, whole garlic, 1 a day conditions. For chronic nephritis and malnutrition, edema. 2. Rice, 30 grams each Gorgon, ginkgo 10 (shell), porridge. Daily for 1 second, 10 for a course of treatment. This porridge with spleen and kidney, Guse convergence fine effect. 3. Kidney 1, Codonopsis, Astragalus, Gorgon each 20 grams. Cut open the kidney, to the fascia cleaned, and the drugs were eating soup. This shall only apply to recovery and chronic nephritis, spleen and kidney qi deficiency patients. 4. Male duck a blue head, rice amount, light blue 3 stems. Chopped green head duck will cook extremely bad, and then Garmisch, light blue porridge or porridge with duck soup, hot food, 5 to 7 days for treatment. This side has replenishing spleen benefits of water swelling effect. Applies to all edema patients. 5. Rice 50 to 100 grams, 5 grams of commercial land. Phytolacca water Jianzhi first, to the residue, then add the rice porridge. 1 day or every other day. For edema and chronic nephritis, cirrhosis with ascites. 6. Fresh water, dry beans or broad beans, 250 grams, 500 grams of lean beef, a little salt. Beef cuts with the beans, put the casserole with salt, then simmer Dunshu rotten food 2 times a day, with the amount of food. 7. Gourd skin, melon skin, peel each 30 grams, 10 grams of dates, with the release of about 400 ml pot, add water, simmer till about 150 ml, to slag Serve. Yin Tang, Day 1, to the swelling subsided so far. 8. Live carp from 1 to 2, 50 grams of rice, the wick to spend 5 to 8. 3 flavor to the amount of water, boiled gruel consumption. 1 day, for chronic nephritis, pyelonephritis. 9. Fresh Chine 200 grams, 200 grams of rice. Chine first wash, the amount of water, boiling for half an hour, winners to the dregs, add the rice washing and continue Zhu Chengyu. Sub-Bent day consumption. 10. Empty stomach every morning, fresh milk 250 to 500 ml, even for 1 month. 11. Clothing with peanuts, red dates each 60 grams of slow fire boiling soup. Fresh peanuts, red dates, Yin Tang, continuous use. 12. Mulberry 30 grams, 20 grams of raw yi, raisins 20 grams, the same amount of porridge of rice, 2 times to take them. 13. Peanuts 120 grams, beans 250 grams, into the casserole with 3 bowls of water within the micro heat and simmer until the water was brown, add appropriate amount of brown sugar to take them. 2 times a day service. 14. Melon 500 grams, 250 grams of carp, add water, amount of clear beef broth, Yin Tang, eating melon, fish. 2 times a day service.


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