Chronic pyelonephritis

　　Chronic pyelonephritis is common in women, and some patients have had acute urinary tract infections in childhood. After treatment, the symptoms disappear, but there is still

　　In chronic bacterial pyelonephritis, most kidney scars and kidney damage occur during infancy, so most serious complications of urinary tract infections are related to infantile pyelonephritis. Although pyelonephritis recurs frequently, kidney and urinary system development is normal in adult patients, and renal scars or functional loss occur rarely. However, patients with adult kidney infections complicated with diabetes, urinary tract stones, and urinary tract obstruction have a risk of progressive renal damage and functional loss. Patients with chronic pyelonephritis are prone to sepsis, hypertension, and kidney stones.

　　More than half of the patients with this disease have a history of

　　The clinical symptoms and signs of chronic pyelonephritis can be divided into two categories: one is the manifestation directly related to infection, and the other is related to the extent and location of kidney damage. The manifestation directly related to infection is often not obvious, and the symptoms are more obvious than those of infection and inflammation. This is due to the long-term damage to the renal tubular interstitium, leading to disorders of kidney physiological function, such as hypertension, loss of sodium retention function (manifested as salt-wasting nephropathy), decreased urine concentration, hyperkalemia, and acidosis tendency. Although these symptoms are present to varying degrees in all kidney diseases, in chronic pyelonephritis, the degree of physiological dysfunction is not parallel to the degree of renal failure (elevated blood creatinine). In other types of kidney diseases, when the blood creatinine level is 2-3 mg/dl, the degree of physiological dysfunction is small; however, in patients with chronic pyelonephritis, when the blood creatinine level is at the same level, polyuria, nocturia, hyperkalemia, and acidosis may already occur.

　　The clinical manifestations of chronic pyelonephritis are complex and tend to recur easily. The main reason is the presence of triggering factors and the deformation of the mucosa of the renal pelvis and calyces and the renal papillae due to scar formation, which is conducive to the latent infection of pathogenic bacteria.

　　The main route of invasion for the causative bacteria of pyelonephritis is ascending infection, and the main preventive measures are as follows:

　　1. It is recommended to drink plenty of water and urinate frequently to flush the bladder and urethra. This is the simplest and most effective measure to prevent the proliferation of bacteria in the urinary tract.

　　2. Pay attention to the cleanliness of the pudendum to reduce the bacterial population at the urethral orifice, and it is necessary to apply neomycin or furazolidone ointment to the mucosa near the urethral orifice or perineal skin when necessary to reduce the ascending recurrent infection.

　　3. Try to avoid using urinary tract instruments, and strict aseptic operation should be performed when necessary.

　　The following are the items of examination for chronic pyelonephritis:
　　First, laboratory examination

　　1. Urinalysis: There may be intermittent purulent urine or hematuria, during acute attacks, it is the same as the manifestation of acute pyelonephritis.

　　2. Urinary cell count: In recent years, the 1h urine cell count method is often used, and its evaluation criteria are: leukocytes > 300,000/h as positive

　　3. Urinary bacteriology: True bacterialuria may occur intermittently, during acute attacks, it is the same as acute pyelonephritis, urine culture is mostly positive.

　　4. Blood routine: Red blood cell count and hemoglobin may be slightly reduced, in acute attacks, the white blood cell count and the proportion of neutrophils may increase.

　　5. Renal function test: Sustained renal function damage may occur: ① Renal concentration function decrease, such as increased nocturnal urine volume, decreased morning urine osmolality; ② Acidification function decrease, such as increased morning urine pH, urine HCO₃^-increase, urine NH4⁺decrease, and ③ Renal glomerular filtration function decrease, such as the reduction of creatinine clearance, blood urea nitrogen, creatinine increase, etc.

　　Second, imaging examination

　　1. X-ray examination: KUB flat film can show that one or both kidneys are smaller than normal, IVU can show that the size of the two kidneys is unequal, the shape is uneven, the renal calyx and pelvis can be deformed, there may be expansion and hydrops, the renal parenchyma is thin, there are focal, rough cortical scars, accompanied by adjacent renal calyces become blunt or drumstick-shaped deformation, sometimes poor shadowing, ureteral dilatation, and some patients have vesicoureteral reflux in micturition excretion造影, in addition, it can also be found that urine flow is not smooth, urinary tract obstruction such as stones, tumors, or congenital malformations and other susceptible factors.

　　2. Radionuclide scan: Can determine the renal function damage of the patient, showing that the affected kidney is smaller, and dynamic scanning can also detect vesicoureteral reflux.

　　3. Cystoscopy: It may be found that there are inflammatory changes at the orifice of the affected ureter, ureteral catheterization is obstructed, and indocyanine green intravenous injection confirms the decreased renal function of the affected kidney.

　　3. Renal biopsy: Light microscopy can show renal tubular atrophy and scar formation, interstitium may have lymphocytes, monocytes infiltration, neutrophils infiltration may occur during acute attack, glomeruli may be normal or slightly glomerular perivascular fibrosis, if there is long-term hypertension, then glomerular capillary wall hardening, glomerular capsule collagen deposition.

　　Chronic pyelonephritis diet should be rich in vitamin A, vitamin B2 and vitamin C foods, such as tomatoes, green leafy vegetables, fresh jujube, watermelon, radish, cucumber, citrus, kiwi, and natural juice, etc.; high biological value protein, such as cooked egg white, fresh milk, lean meat, etc., to supplement the excretory loss; various vegetable and fruit juices, such as orange juice, watermelon juice, orange juice, and vegetable juice, etc., for diuresis and edema reduction.

　　Western treatment for chronic pyelonephritis:
　　One, General Treatment
　　Find and eliminate the susceptible factors leading to the onset of chronic pyelonephritis, relieve urinary tract obstruction, correct urinary tract deformity, and improve the body's immune function. For patients with kidney function damage, attention should be paid to maintain electrolyte balance. For patients with hypertension, antihypertensive treatment should be given.
　　Two, Antibiotic Treatment
　　The antibacterial drugs selected for chronic pyelonephritis are similar to those for acute pyelonephritis, but the treatment is more difficult during the acute period. Once improperly handled, not only the efficacy is poor, but also the prognosis is affected due to kidney function damage. The principle of antibacterial treatment for chronic pyelonephritis is:
　　1. It often requires the combined use of two types of drugs, and it can be integrated with traditional Chinese and Western medicine treatment when necessary.
　　2. The course of treatment can be appropriately extended, usually 2-4 weeks, if ineffective or recurrence is found during re-examination, sensitive drugs can be selected and divided into 2-4 groups for alternate use, each group of drugs for one course of treatment, stop taking medication for 3-5 days after the end of the course, a total of 2-4 months. If the above long-term antibacterial treatment is still ineffective or often recurs, low-dose long-term antibacterial treatment can be adopted. Clinical commonly used sulfamethoxazole/trimethoprim (sulfamethoxazole/trimethoprim), nitrofurantoin (nitrofurantoin), cefametin (cefametin), amoxicillin, norfloxacin, and other drugs, one dose at a time, taken before going to bed after urination, can be taken for a long time up to 6-12 months, which can prevent recurrence, especially effective for chronic pyelonephritis caused by re-infection.
　　3. While antibacterial treatment is being carried out, especially when the efficacy is poor or it recurs frequently, it is necessary to find and eliminate the susceptible factors.
　　4. The medication during the acute attack is the same as that for acute pyelonephritis.
　　Three, Surgical Treatment
　　For urinary tract infections that are difficult to cure, it is necessary to apply surgical correction as much as possible to correct urinary tract obstruction or deformity. Active antibiotic treatment should be carried out before surgery to reduce bacteriuria to less than 1000/ml, and antibacterial drugs should be used after surgery to prevent sepsis.
　　Four, Cure Standard
　　1. After the disappearance of clinical symptoms, stop taking medication 72 hours later, and perform urine routine and bacterial culture every 2-3 days for 3 consecutive times, all negative.
　　2. After clinical cure, urine routine and bacterial culture should be re-examined 1-2 times a month for half a year, and all negative continuously.