Elderly chronic pyelonephritis

　　What are the causes of the onset of chronic pyelonephritis in the elderly

　　This disease is caused by direct infection of the kidneys by bacteria, and the general causes of chronic pyelonephritis in the elderly include the following points:

　　1. The immune function of the elderly decreases, and the ability to resist infection is insufficient, which plays an important role in the occurrence of urinary tract infections. The elderly have a decreased responsiveness to stress, and the incidence of malnutrition (such as vitamin or zinc deficiency) is high, which may be the reason for the decreased or delayed cell-mediated immune response in the elderly. The function of polymorphonuclear leukocytes may have a more direct relationship with the defense against urinary tract infections. Elderly patients with diabetes have intermittent abnormalities in these cell functions, and patients with myeloproliferative and lymphoproliferative diseases have persistent abnormalities. Some people have found that the level of circulating IgM in the elderly decreases, and the level of antibodies produced by the elderly against various vaccines is generally lower than that of young people. In addition, the normal sterile urinary system only contains a small amount of immunoglobulin (IgA), macrophages, and phagocytes, so the resistance to bacterial invasion is very low. This not only makes the urinary system prone to infection and difficult to cure, but also often recurrent, long-lasting, and becomes one of the important causes of renal failure.

　　3. The physiological thirst sensation in the elderly decreases, leading to reduced water intake. At the same time, the elderly often abuse analgesics, non-steroidal anti-inflammatory drugs, and other medications, which are prone to cause chronic pyelonephritis and chronic interstitial nephritis. 2. The elderly often have various chronic diseases, which increase the incidence of chronic pyelonephritis. Neurological diseases such as stroke and elderly dementia patients with poor personal hygiene are prone to incontinence of urine and feces, and perineal contamination increases the incidence of bacteriuria in elderly women. The incidence of pyelonephritis in diabetic patients may be caused by abnormal function of polymorphonuclear leukocytes related to hyperglycemia, recurrent vaginitis, and incomplete bladder function. The renal infection in patients with chronic kidney disease may be related to local defense defects in the kidneys themselves.

　　This disease can complicate anemia, electrolyte disorder, glomerulosclerosis, renal failure, and other complications, among which anemia is the most common complication. In the late stage of chronic nephritis, renal parenchymal damage can complicate various abnormalities in the blood system, such as anemia, abnormal platelet function, abnormal lymphocyte function, and coagulation mechanism disorders. The main reasons for anemia include reduced red blood cell production, increased red blood cell destruction, and increased blood loss.

　　The clinical manifestations of chronic pyelonephritis in the elderly are often atypical, complex and diverse. In severe cases, acute onset may present with a syndrome similar to acute pyelonephritis, with obvious systemic infection symptoms. Common symptoms include general discomfort, weight loss, low fever, urinary incontinence, difficulty in urination, urinary retention, polyuria, nocturia, etc. A few patients may present with back pain, abdominal pain, or renal colic. Mild cases may be asymptomatic or only have changes in urine, and some patients may have hypertension.

　　Chronic pyelonephritis is an important disease leading to elderly mortality, and general prevention of the disease can adopt the following three-level prevention measures:

　　1. First-level prevention

　　The first level of prevention refers to the start of prevention before the occurrence of chronic pyelonephritis. At this stage, it is recommended to drink more water, eat light and bland food, avoid greasy, spicy, and hot food, pay attention to perineal hygiene, rest appropriately, avoid holding urine and overindulgence, and at the same time, enhance physical fitness and improve the body's defense ability.

　　2. Second-level prevention

　　The second level of prevention, known as the 'three early' (early detection, early diagnosis, early treatment) prevention. A urine routine test, urine culture, and renal ultrasound examination should be performed once a year.

　　3. Third-level prevention

　　The third level of prevention, also known as rehabilitation treatment. For chronic pyelonephritis that has already occurred, active treatment should be carried out to prevent its progression to chronic renal failure. For those who often relapse, low-dose long-term antibacterial treatment can be adopted.

　　The clinical manifestations of chronic pyelonephritis in the elderly are often atypical and complex, and to confirm the diagnosis of this disease, the following examination methods need to be adopted:

　　1. Urinalysis

　　Detection shows an increase in leukocytes, and if leukocytes (or pus cells) casts are seen, it indicates that the lesion is in the upper urinary tract. Red blood cells can also increase, and even gross hematuria can occur in patients with hematuria. Urinary protein can also increase, but generally

　　2. Urinary bacterial examination

　　The method of collecting urine specimens directly affects the accuracy of the diagnosis. The first midstream urine in the morning is still the preferred method, followed by catheterization and suprapubic bladder puncture to collect urine. However, 40% to 60% of the elderly have varying degrees of urinary incontinence, and the outer tube collection method can be used. This method is more sensitive (100%) and specific (94%) than catheterization. After collecting the specimen, if it is not immediately cultured, it should be placed in the refrigerator for storage. Bacteria can multiply in urine specimens left at room temperature for more than 2 hours.

　　3. Urine cell count

　　In recent years, the 1-hour urine cell count method has been widely used, with the evaluation criteria being that 300,000 cells/hour is positive, less than 200,000 cells/hour is negative, and between 200,000 and 300,000 cells/hour requires clinical judgment. Urine cell count is often used in the chronic stage of the disease, especially when the routine urine test shows no obvious abnormalities, multiple urine cultures show no positive results, and there are no specific clinical manifestations.

　　4. Blood routine examination

　　During the acute stage, the count of blood leukocytes and neutrophils can increase, and during the chronic stage, the count of red blood cells and hemoglobin can slightly decrease.

　　5. X-ray examination

　　For chronic or refractory cases, according to the need, plain film of the urinary tract, intravenous pyelography, retrograde pyelography, and cystoureterography during micturition can be performed to check for obstruction, calculi, ureteral stenosis or compression, kidney ptosis, congenital malformation of the urinary system, and vesicoureteral reflux phenomenon, etc. In addition, it can also understand the morphology and function of the renal pelvis and calyces, and use them to differentiate from renal tuberculosis and renal tumors.

　　6. Isotope renal imaging examination

　　Isotope renal imaging can understand renal function, urinary tract obstruction, vesicoureteral reflux, and residual urine in the bladder.

　　7. Ultrasonic examination

　　Ultrasonic examination is the most widely used and simplest method, which can screen for urinary tract malformation, congenital malformation, polycystic kidney, uneven kidney size caused by renal artery stenosis, calculi, severe hydronephrosis, tumors, and prostate diseases.

　　For patients with senile chronic pyelonephritis in the early stage of the disease or with nitrogen retention, a low-calorie, low-protein, low-fat diet should be adopted. Most of the dietary calories are provided by sugar, and a low-salt diet should be given as appropriate. Edible vegetables such as amaranth, milk, sheep milk, green vegetables, spinach, chive, cabbage, lettuce, winter melon, carrot, pear, apple, orange, banana, hawthorn, watermelon, pineapple, peach, star fruit, loquat can be selected.

　　During the convalescence period, it is advisable to use yam, jujube, longan, lotus seed, chestnut, walnut kernel, red bean, mung bean, glutinous rice, turtle, lean meat. It is forbidden to use foods with strong刺激性, high purine content, and spicy and fishy foods, such as chili, garlic, pepper, cinnamon, ginger, chive, rapeseed, radish, scallion, taro, linden leaf, mint, rabbit meat, donkey meat, mule meat, fish, shrimp, citrus, pomelo, dried fruit.

　　Bacterial infection is the direct cause of senile chronic pyelonephritis, and the following is an introduction to the common methods of treating this disease:

　　1. General Treatment

　　For chronic pyelonephritis, the first priority is to find and remove the susceptible factors that cause the disease, especially to relieve urinary obstruction, correct renal and urinary tract malformations, and improve the body's immune function. It must be pointed out that only after finding and removing the existing susceptible factors can a complete and effective treatment be achieved without recurrence. At the same time, it is very important to pay attention to drinking plenty of water, urinating frequently, and increasing nutrition.

　　2. Antimicrobial Drug Treatment

　　The antibacterial drugs used in the chronic stage are similar to those for acute pyelonephritis, but the treatment is more difficult in the chronic stage. If not handled properly, not only is the efficacy poor, but it is also easy to cause renal function damage and affect the prognosis.

　　Recurrences often occur within 6 weeks after the cessation of antibacterial drug treatment for the previous episode, which is essentially the failure of the previous treatment, so it is necessary to change to sensitive drugs or change the treatment approach, method, and course, etc. Re-infection often occurs more than 6 weeks after the previous treatment stops, and is often related to decreased immune function of the body. At the same time as adjusting the drug treatment, it is necessary to enhance the immune function.

　　Hidden type chronic pyelonephritis may not have clinical symptoms, but the persistent bacteriuria, and renal inflammation and renal function damage may also occur. Especially for pregnant women, infants, urinary tract malformations, and diabetics, antimicrobial therapy should be done to maintain the sterile state of urine.