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18ON THE ISSUE OF DIAGNOSIS AND DIRECTIONS IN THE TREATMENT OF ACUTE
GESTATIONAL PYELONEPHRITIS
Kadohova L.
student of the Faculty of Medicine of the FSBEI HE "NOSMA" MOH Russia, Vladikavkaz
Safarova Z.
student of the Faculty of Medicine of the FSBEI HE "NOSMA" MOH Russia, Vladikavkaz
Abstract
The article presents the results of a study of the course and treatment of 13 cases of acute gestational pyelonephritis in the nephrology department of the Republican Clinical Hospital (Vladikavkaz). Clinic issues, diagnostics and modern treatment were also discussed; relevant conclusions are made.
Keywords: pyelonephritis, gestation, urethra, pregnancy, excretory urography.
According to clinical observations, gestational pyelonephritis is observed in 1-12% of pregnant women, and the presence of stones in the urinary tract - in 0.030.8%. Gestational pyelonephritis is a serious complication of pregnancy, has an adverse effect on the course of pregnancy and the physiological state of the fetus. With this pathology, pregnancy is complicated by the development of toxicosis in 41-50% of women [1, p. 31], in 1/3 of pregnant women, an exacerbation of the chronic inflammatory process in the renal tissue is observed. Most often, the disease is observed in pre-preg-nant women aged 18-25 years in the II trimester of pregnancy. Over the past 20 years, an increase in the frequency of pathology has been noted.
In pregnant women and in puerperas, chronic pyelonephritis is regarded as gestational, regardless of the time of detection. In addition, with the development of pregnancy and an increase in the uterus, an exacerbation of pyelonephritis and an increase in attacks of renal colic can occur.
Diagnosis of acute pyelonephritis during pregnancy is difficult. Palpation of the kidneys is uninformative due to an enlarged uterus. X-ray and radio-nuclide research methods are contraindicated.
Ultrasound has the greatest diagnostic value, which makes it possible to simultaneously assess the condition of the mother's kidneys and the condition of the fetus; allows you to identify the expansion of the cavity system of the kidney, the presence of calculi in the urinary tract and changes in the paranephral tissue.
Ultrasound of the kidneys should be the first step in the diagnosis of pyelonephritis in pregnant women.
In the analysis of urine: bacteriuria, leukocyturia, minor proteinuria, microhematuria and moderate cylin-druria are possible. The appearance of macrohematuria is a poor prognostic sign and often indicates destruction of the kidney papilla - necrotic papillitis.
In the blood test: leukocytosis with a shift of the leukocyte formula to the left, the appearance of young forms of neutrophils, toxic granularity of neutrophils, aneosinophilia, a moderate decrease in Hb level, a significant increase in ESR. In severe cases of the disease and damage to both kidneys with the development of
renal-hepatic insufficiency, azotemia and hyperbiliru-binemia appear in the blood [6].
Mandatory is urine culture for sterility and the determination of sensitivity to antibiotics before antibiotic therapy.
Excretory urography is used in the following situations: bilateral damage to the kidneys, the unclear anatomical and functional state of the opposite kidney, and in cases where there is a question about the life of a woman.
Treatment of acute gestational pyelonephritis is carried out in a hospital and can be conservative and surgical.
Features of the treatment of pregnant pyelonephritis are determined by the presence of a violation of uro-dynamics and the possibility of toxic effects of drugs on the fetus.
Treatment of gestational pyelonephritis should be lengthy. If treatment is carried out only for 2 weeks, then the relapse rate is up to 60%.
Materials and research methods. The study was conducted in the Republican Clinical Hospital, Vladikavkaz. At the time of the internship, 6 patients were treated with gestational pyelonephritis in the nephrol-ogy department with 48 beds, 6 patients. To obtain a more detailed picture of the study, an analysis of archival case histories was carried out. In total, 13 case histories were involved in the study.
The purpose of the study risk factors for development and laboratory parameters in gestational pyelonephritis.
The results of the study. By age, patients were divided into the following groups:
• 18-25 years - 2 (15.4%);
• 26-35 years - 8 (61.5%);
• older than 35 years - 3 (23.1%).
By the gestational age were the following results:
• I trimester - 4 (30.8%);
• II trimester - 8 (61.5%);
• III trimester - 1 (7.7%).
Laboratory parameters of urine and blood were studied for gestational pyelonephritis.
Table 2
Table 1
Urine counts are normal and with gestational pyelonephritis
Urine counts Normal indicators Research Results
Color straw yellow brownish red
Transparency transparent muddy
Smell unsharp cutting
pH 4-7 10,5
Density 1.012-1.022 g/l 1.010 g/l
Protein 0.033 g/l 0.084%
Glucose up to 0.8 mmol/l 0,6 mmol/l
Ketone bodies are absent -
Urobilinogen 5-10 mg/l 9,5 mg/l
Hb are absent are absent
Erythrocyte up to 3 in sight 4.8
Leucocytes up to 6 in sight 7.3
Epithelial up to 10 in sight 13.4
Salt are absent urine oxalates
Bacteria are absent are present
Table 2 Blood counts are normal and with gestational pyelonephritis
Indicators Normal indicators Research Results
ESR 2.0-15.0 mm/h 19.5
Hb 120-140 g/l 98.4
Erythrocyte 3.9-4.7 • 1012 /l 4.3
Color index 0.85-1.05% 0.92
Hematocrit 0.36-0.49 0.38
Platelets 180-320 • 109/l 228.38
Leucocytes 4.0-9.0 • 109/l 12.2
Lymphocytes 19.0-37.0% 21.14
Monocytes 3.0-11.0% 4.95
Conclusion. Gestational pyelonephritis is more common in patients aged 26-35 years in the second trimester of pregnancy.
For gestational pyelonephritis, a characteristic change in urinalysis is a change in color, transparency, an increase in white blood cells and protein. In the blood of patients with gestational pyelonephritis, leu-kocytosis, a neutrophilic shift of the leukocyte formula to the left due to an increase in stab forms, and hypo-chromic anemia are observed.
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