Pregnancy complicated by acute pyelonephritis

　　Pregnancy complicated with acute pyelonephritis is often caused by ascending infection of the bladder, and it can also be caused by lymphatic or hematogenous infection, and occasionally it can spread from the infection of renal perinephric tissue, so patients often have symptoms such as frequent urination, urgency, and dysuria, etc. of urinary tract irritation.

　　The main complications of acute pyelonephritis during pregnancy are as follows.

　　1. Endotoxemia and septic shock: The appearance of clinical symptoms such as excessive drop in body temperature (below 35℃) is often a sign of endotoxemia and septic shock.

　　2. Anemia: Lipopolysaccharides contained in Escherichia coli endotoxin can destroy red blood cells and cause anemia.

　　3. Lung damage: Endotoxin injury to alveoli can lead to pulmonary edema.

　　The main clinical manifestations of pregnancy complicated with acute pyelonephritis are as follows:

　　1. General symptoms

　　Patients have an acute onset, often with chills, high fever, malaise, fatigue, decreased appetite, nausea and vomiting, and even abdominal distension, abdominal pain, or diarrhea. If the high fever does not subside, it often indicates the coexistence of urinary tract obstruction, renal abscess, or sepsis.

　　2. Urinary tract irritation symptoms

　　Pyelonephritis is often caused by ascending infection, so it is often accompanied by cystitis, and patients may have symptoms such as frequent urination, urgency, and dysuria, etc. of urinary tract irritation.

　　3. Local signs

　　Pain in one or both renal areas of pregnant women, with tenderness and percussion tenderness at the rib-flank point, and deep tenderness at the upper and middle ureteral points.

　　Strengthen prenatal care, improve health level. Pay attention to the cleanliness of the perineum, after defecation, the toilet paper should be wiped from the front to the back to reduce the chance of intestinal bacterial contamination of the anterior fornix and urethral orifice, and wash the perineum every night. Treat asymptomatic bacteriuria. Active treatment of acute cystitis is of positive significance in preventing ascending infection. Lying on the left side frequently is conducive to urine drainage and preventing the occurrence of infection.

　　The main examinations for pregnancy complicated with acute pyelonephritis are as follows:

　　1. Urine examination

　　Urine specific gravity is increased, usually between 1.022 and 1.032. During edema, urine output is reduced, ranging from 400 to 700ml, and a few people may have less than 300ml. During the recovery period, urine output can reach 2000ml. Urine sediment contains many red blood cells or red blood cell casts. Most patients have varying degrees of renal insufficiency, with the most obvious change being the renal function filtration rate. The creatinine clearance rate and inulin clearance rate are both reduced.

　　2. Fundus examination

　　Most patients have normal fundus, a few may appear minor arteriospasm and mild optic disc edema. If pregnant women have symptoms such as hemorrhage and exudation, it is likely to be an acute exacerbation of chronic glomerulonephritis.

　　Pregnancy complicated with acute pyelonephritis should pay attention to the following aspects in diet:

　　1. The dietary principles should be determined based on the patient's renal function status and the degree of proteinuria. Attention should also be paid to the patient's edema and blood pressure conditions, and a comprehensive analysis should be made before determining the diet.

　　2. Patients with acute pyelonephritis should pay attention to drinking plenty of water, keeping the bowels regular, and ensuring urination every 3-4 hours during the day. Avoid spicy and刺激性 foods, and refrain from drinking alcohol. Eat less sweet and greasy foods.

　　3. Patients with acute pyelonephritis should limit protein intake. When the condition improves and urine output increases, and the daily urine output is greater than 1000 milliliters, protein intake can be gradually increased, and high-quality protein foods such as milk, eggs, lean meat, fish, etc., can be selected.

　　4. Patients with edema and hypertension should adopt a low-sodium or salt-free diet. Salt-free diet means not adding salt or soy sauce during cooking, and sugar, vinegar, sesame paste, and tomato sauce can be used for seasoning.

　　5. When oliguria, anuria, or elevated blood potassium levels occur, limit the intake of vegetables and fruits rich in potassium in the diet of acute pyelonephritis, such as soybean sprouts, chives, green garlic, celery, cauliflower, toon, spinach, bamboo shoots, lily, dried red dates, fresh mushrooms, seaweed, sauerkraut, Sichuan winter vegetables, winter mushrooms, apricots, lotus root, sorghum, corn, mung beans, tomatoes, luffa, bitter melon, etc.

　　The following points should be noted when treating pregnancy complicated with acute pyelonephritis:

　　1. Acute pyelonephritis should be treated in the hospital. Pregnant women should rest in bed and adopt a lateral position, mainly the left lateral position, which can reduce the pressure of the uterus on the ureter and ensure smooth urine flow.

　　2. Take active measures to reduce fever during persistent high fever to reduce the risk of miscarriage and preterm birth.

　　3. Encourage pregnant women to drink plenty of water to dilute urine. Maintain a urine output of more than 2000ml per day. However, most patients with acute pyelonephritis have nausea, vomiting, dehydration, and cannot tolerate oral fluids and drugs, so rehydration and parenteral administration of treatment should be given.

　　4. Monitor the mother and child's condition, regularly check the mother's vital signs, including blood pressure, respiration, pulse, and urine output, and monitor the condition of the fetus in the uterus.

　　5. Effective antibiotic treatment should be given. The use of cephalosporins and newer broad-spectrum penicillins can achieve a cure rate of 85% to 90%. Generally, medication should be continued for 10 to 14 days.