Already more than half of the century has passed since the first successful kidney transplant operation was carried out. Today, in transplantology, this operation is carried out more often than others. Every year more than ten thousand such operations are held in the United States, and in Russia about 1000, extending the lives of many people, including infants, for 6-20 years. For more than 50 years of practice, a clear technique has been developed, so the kidney transplant passes step by step and is clearly calculated in time.

General

Kidney transplantation is a surgical transfers to a given organ from the donor (living or taking the body kidney) to the patient. Sometimes, leaving the own body, the new kidney is transplanted at the same place, near, but it is most often placed in the iliac region. When transplanting from an adult to a child whose weight does not exceed 20 kg, the placement of the kidney is carried out in abdominal cavity kid.

Note! As a rule, the patient's patient is left, it is removed only in some cases (for example, with too much of its size, polycystic), when there is not enough space to accommodate a number of donor kidneys.

The kidney transplant operation takes place with the mandatory preliminary preparation of the patient and the donor body. The kidney after extracting it at the donor is prepared, frozen by placing in a special container. Immediately before the operation was washed, then placed in the patient's body, quickly placing vessels, nerves and ureters (which can be donor).

For reference: According to the international classification of diseases (ICD) there is a special encoding of each of the diseases, and the kidney transplantation also has its own codes on the ICD-10. According to this encoding, the kidney donor indicates the code Z52.4, for the presence of the transplanted kidney indicates the Z94.0 code, about the transplant rejection or complication after operations, the code T86.1 indicates.

Indications for transplant

The kidney transplant is shown only when it is impossible to restore the functions of this organ, that is, in the thermal stage, chronic renal failure. This state may arise as a consequence of many diseases, among them:

• Injury of the urine-forming organ;
• Congenital defects, anomalies;
• Chronic form of pyelonephritis or glomerulonephritis;
• Renal polycystic;
• Nephropathy diabetic;
• Nephritis, due to the development of red lupus, other diseases.

Renewable renal therapy, in the form of peritoneal dialysis and hemodialysis, may be carried out by the patient for several years. As part of this therapy, kidney transplantation is carried out. Thanks to the transplant of the body, subject to good survival, the patient can live a few years a full-fledged life, without the need to pass hemodialysis every few days. The kidney transplant for children is especially acute in view of the fact that the blood purification procedure with hemodialysis seriously slows down the development of the child.

Contraindications for transplant

To date, there are a number of absolute contraindications for transplantation and a number of relatives. Relative relatives relate to diseases that can potentially provoke complications after the operation, among them:

• hemolytic uremic syndrome;
• glomerulonephritis membrane-proliferative;
• violations of metabolism provoking deposits in the renal structure (for example, gout), etc.

The kidney transplant is not carried out with the following absolute contraindications:

• Recently removal of cancer tumor or its presence;
• Severe active infections (for example, HIV or tuberculosis);
• Chronic diseases in their acute or severe form;
• Immunological cross reaction with donor lymphocytes in this patient;
• Decompensated stage of cardiovascular diseases;
• Serious personality changes, in view of which the patient is not capable of adapting after the organ transplantation.

Note! Sugar diabetes, inactive forms of hepatitis B and C are not contraindications for the operation. Simultaneously with the kidneys, during one operation, transplantation and pancreas can be carried out (which is relevant for diabetic patients).

Types and compatibility of grafts

Kidney transplantation is with an organ obtained from a corpse or from a living person (most often a relative). In the second case, the survival rate is quite high with the full restoration of functions. Compatibility is determined by three main parameters:

• compatibility of alleles of HLA-genes of the donor and the patient to whom the transplant will be conducted;
• compliance with the group of blood recipient and donor;
• matching by age, weight, floor. Preferably, it is not always observed.

According to statistical data, the survival rate of the recipient with a body taken from a living person is 98%, the observing of the organ itself is in 94% of cases. With the kidney seized from the corpse, patients survive in 94%, and the transplant itself is caring in 88% of cases.

Note! The safest transplant is considered the "live" transplantation, where the donor is a living relative. However, not all relatives who are able to sacrifice the kidney without prejudice to their health, and have the same blood group, the level of leukocyte agents (HLA study).

The donor should not have the following diseases:

• hepatitis B and C in acute form proceedings;
• HIV and AIDS;
• tuberculosis;
• venereal diseases;
• glice invasions.

Taking into account all these requirements, the circle of potential donors is significantly narrowed. Transplantologists offer to expand the criteria by posthumous renal seizure, the use of organs of the elderly who died from pathologies of other organs. However, these methods meet disapproval among people.

Cadic kidneys are withdrawn immediately after the onset biological death donor. Such a graft according to one of the techniques is purified from the blood and connects to the special device of artificial pumping liquids, then continuously washed by a preservative solution (Viaspan, Eurocollins, UW, Custodiol). On another, less costly technique, a system of triple packets are used during storage not higher than 5-6 ° C. For this:

1. Blood purified from blood is placed in a sterile package with a preservative solution;
2. This package is placed in the second, with a layer of sterile snow;
3. The outer third package is filled with ice physiological saline.

The best indicators of the transplant survival are noted during transplantation in the first 24 hours after the seizure, but in these conditions the body may be up to 72 hours. As a rule, the operation is carried out as soon as a suitable organ appears. Recipient All this time can be at home or in the hospital, waiting for its turn. If the kidney was obtained from a living donor, it takes on much better than the body. This is explained by the fact that the body did not suffer from cold ischemia and the donor was carefully examined.

Today in Russian Federation The kidney transplantation is allowed only from a capable close relative, who has given its voluntary consent to the withdrawal and transplantation of the body from 18 to 65 years.

Preparation and necessary analyzes

Kidney transplant requires special training. A group of specialists is prepared for the recipient operation: surgeon, anesthesiologist, nephrologist-transplantologist, junior medical personnel, psychologist, and even a nutritionist. If the donor acts a living person, then the preparation can be thorough and long, and in the case of a body kidney, the patient can call in the clinic as an emergency (according to the queue in the list of expectations in transplant). A number of special compatibility tests are carried out (especially in the case of a corpus organ), and if there is a large risk of rejection, the patient may be invited to expect the next more suitable organ.

The required laboratory and instrumental analyzes conducted before the operation include:

• Blood test: for creatine, urea level, hemoglobin, calcium level, potassium, etc.;
• X-ray or ultrasound;
• Hemodialysis (is carried out in the absence of contraindications in adults, children are usually not held).

Period after surgery

To suppress the immune response to the transplant on the day of operation, special preparations are prescribed (for example, prednisone, funk, cyclosporin), which significantly increases the observing of the organ. Receiving data of immunosuppressants can last up to 3-6 months after a transplantation.

The next day, after the operation, the patient is allowed to walk. The period of staying in the hospital is about 1-2 weeks, after which the patient with a new kidney is released home, with a mandatory regular home measuring body temperature, level arterial pressure et al. In addition, it is necessary to monitor the body weight, comply with a special diet, control the diuresis.

During the first after the discharge of the attending physician, the seams are removed (about 10-14 days after discharge). The dispensary inspection is carried out every 2 weeks, then less often and until the end of life it is necessary to visit the at least 1 time per month.

During the dispensary inspection is carried out:

• Verification level of blood pressure;
• Checking the density of the transplanted organ;
• There is noise of vessels over the transplant;
• Domez is checked;
• General urine analysis and daily protein;
• Blood test for biochemistry and general;
• Twice a year it is necessary to hand over blood for urinary acid and lipids;
• At least once a year, ECG, ultrasound, fluorography and other necessary types of research are carried out.

Life after transplant

Patients with chronic renal failure receive up to 20 years of full life with a new organ. In the case of a body kidney, a person receives an additional from 6 to 10 years of life, and in the case of an organ from a living person (relative) - 15-20 years.

After transplantation, a special diet with a reduced salt content, sugar is recommended, the use of bakery products is reduced, smoked and fried dishes are avoided. Liquid volume is also limited to 1.5-2 liters. Optimal is considered dietary table №7.

After transplanting, it is impossible to raise gravity (up to 5 kg, and after 6 months - up to 10 kg) and intense physical exercise. However, moderate physical exercises and the load are welcome and is considered useful in the period of rehabilitation (especially in transplanting the corpse kidney).

Important. In addition, it is necessary to exclude sexual infections that require serious treatment. For these purposes, barrier contraception is recommended. You can pregnant after transplanting, but only after consulting with the attending physician and an obstetrician-gynecologist to evaluate all possible risks.

Possible complications

The most important complication after the transplant is the rejection of the body. Experts identify three types of rejection:

1. Superfluous. Happens 1 hour after the operation. Extremely rare case;
2. Sharp. Happens in postoperative period for 5-21 days after the operation;
3. Chronic. In terms of limitations has no restrictions.

Mostly the signs that the kidney does not come true, it is gradually and using medications this process can be stopped. However, if, if the kidney fails to work, the chronic rejection syndrome continues to grow, then retransplantation is required, that is, a new transplant.

To others possible complications relate:

• Urological character (hypertension, thrombosis, bleeding, stenosis of arteries in transplanted kidney and others);
• Vascular character (hematuria, blockage of the lumen of the ureter and others)

As after any other operation, the infection of the postoperative seam is also considered a possible complication.

Features of Microhematuria

If the number of erythrocytes in the urine has become too high, then this indicates the appearance of hematuria. This disease is 2 types: microhematuria and macrohematuria.

In the second case, urine changes the color, it turns out the shade of meat lesions. And the first variant of the disease is determined only with the help of a laboratory. It is impossible to determine visually, no symptoms are observed.

Distinction between the types of pathology

Hematuria is distinguished by two types: microscopic and macroscopic. Macroscopic form of doctors can determine with the help of a modified urine color, and microhematuria only according to the results of the analysis of the analyzes. Thus, the difference between these methods in the definition of the disease. But in the first and in the second embodiment, the appearance of blood in the urine is a violation of the genitourinary system.

Causes of appearance

To learn about the appearance of the disease, it is necessary to pass urine analysis. The urine sediment microde is carried out. As a result, the patient learns about increased red blood cells. It says O. initial stage Hematuria or small form.

In such cases, it is necessary to complete a full examination, determine and cure the cause of the disease. In most cases, in parallel with this disease, a disorder of the kidneys and the ureasual canal of light shape appear.

The consequence of the appearance of hematuria is also diffuse or focal jade, as well as various infections. The development of the disease is often due to an increase in prostate or after taking drugs that dilute blood.

Cistoscopy is carried out in the formation of the initial stage of the tumor process in bladder bubble. Microhematuria is more common among paints and aniline companies. The following manifestations are known for its signs:

• female swelling;
• discomfort during urination.

Symptoms of the disease

In the development of the disease, a person often goes to the toilet very often, while painfulness. This indicates the inflammation of the urethra.

If there is pain in the abdomen or sides, this indicates the appearance of the terennel nephropathy or uretera disease. In such cases, the temperature is usually increased, which shows the formation of inflammation or injury of the kidneys, as well as the development of a malignant tumor.

If hematuria has listed symptoms, then it is necessary to undergo a bacteriological examination of urine to determine the reason for their occurrence. In disruption of urination during the development period, bladder carcinomas appear. To identify them, a cytological study is required.

Microhematuria in men

Such a disease is considered fairly common among men. But it is not a major disease, but a symptom of a rather serious illness. The man himself rarely defines this symptom qualified this can only make physicians using tests to determine the number of red blood cells. The reasons due to which the disease appears in men, the following:

• a benign prostate tumor;
• urolithiasis;
• oncology of prostate;
• bladder injury;
• anemia;
• nephropathy kidneys;
• varicose veins;
• polyps of urethra;

• congenital defects;
• the presence of thromboms in the body;
• blood blood clotting;
• infection urinary tract;
• viral infections;
• high blood pressure;
• physical overload;
• inxication in the body.

Regardless of the reason, the man is obliged to come to the urologist. If you ignore the disease, then the consequences can be more than serious. By appointment of a doctor, the patient gives all the necessary analyzes, after which conservative treatment is individually selected.

If the disease occurs in easy form, therapy is carried out using medicinal preparations. But if the disease threatens the life of a man, then it is necessary to carry out an operation.

Treatment of disease in men

The purpose of treatment is to eliminate the causes of the appearance of the disease. The features of therapy are:

• to eliminate inflammation it is necessary to take antibacterial drugs. The duration of therapy, the type of drug and the dosage is also appointed by the doctor;
• to determine the urethra or concrete in the urinary tracts are assigned antispasmodic drugs and thermal procedures;
• to stop the bleeding, it is necessary to make medicines such as ditinon, aminocaproic acid and viscas;
• if protein increases with hematuria, the doctor prescribes corticosteroids;
• in infections, antibiotics take and pass regular analyzes;
• if there is nephropathy kidneys, surgical intervention is necessary;
• if the microhematurium is chronic, it is required to take vitamins B and medicines that contribute to the increase in iron;
• strict observance of beddown.

The method of treatment for each person will be assigned individually.

In addition to drugs, you should contact folk medicine. More effective ragners of such plants like nettle and yarrow. They are not inferior to the leaves of the Tolokniki and barley seeds.

The survey must be taken immediately, after which they carry out therapy, otherwise the disease will become developing and in some cases converts into cancer.

Code on the ICD.

The ICD is an international classification of disease. It was formed by the World Health Organization to encode diagnoses. It is intended for standard healthcare assessment.

The disease has the following codes in this classification:

• N02-9 is the main hematuria with characteristic modifications;
• R31 - Nonspecific hematuria.

Disease in children

A child to determine this disease is easier than an adult. This is because parents annually lead it to a complete study. If microhematuria is found in children, this indicates the appearance of the diseases of the urogenital system, injuries internal organs or kidney disease.

Known causes of the appearance of this disease in childhood are:

• acute cystitis;
• congenital bladder and kidney defects;
• bladder injury;
• violation in blood circulation;
• the side effect of drug intake;
• pathology of vessels;
• urolithiasis;
• bladder papilloma;
• foreign body in urethra.

Assigns an nephrologist therapy. The method of therapy will depend on the results of analyzes and causes the disease. Before appointing treatment, the doctor is obliged to check the intolerance to this or that drug, as well as the state of the child's health. How much the therapy will last, the doctor defines.

Often the doctor appoints the course of antibiotics and compliance with the beddown. If the form is heavier, then without surgery can not do.

After the diagnosis is delivered, the doctor is obliged to identify the cause of his appearance. This is required for proper treatment and eliminate this process.

Treatment of disease in children

If with the help of the analysis revealed in the urine of the baby, the cinema stick, then the doctor is obliged to prescribe treatment with the help of antibiotics.

Effective drug is ceftriaxone. During the period of therapy with this medicine, the child will go to the toilet less often. It is impossible to give drugs on their own, only by appointing a doctor, otherwise an increased sensitivity of the organs occurs.

It is necessary to observe a strict diet. A large amount of fried food, salt, smoked, as well as chemicals is prohibited. nutritional supplements and vitamins.

After the course of treatment, it is required to pass all urine tests and blood. Regular visit to the nebologist is also necessary.

As for the treatment with the help of herbs, thunderstorms are effective rags of yarrow and nettle, as well as rosehip, blackberry root and peony and juniper. Before taking these decoctions, you must consult with your doctor.

The renal hematurium is formed with a violation of the kidneys, venous outflow.

Pregnancy

The formation of microhematuria during the period of pregnancy in women is observed for 2-3 months. The intensive growth of the fetus poorly affects the performance of the kidneys, and also transfers the ureter of the uterus.

If the urine is stirred in Lohanka, then stones may form, which subsequently damage the epithelium and contributes to the appearance of bleeding in women.

It is important not to confuse bleeding from urinary tract with bleeding from the uterus. If blood appears from the uterus, then this is a threat to the child and for the mother.

Microhematuria often arises due to anticoagulant taking. As well as the risk of formation of this disease increases, if women had inflammation of the kidneys or a pyelonephritis, which is chronic.

Pyelonephritis is an inflammatory kidney disease. Lohanks and fabric are affected directly (mostly intermediate). People of all ages are sick, but in women, due to structural features, pathology occurs more often than in men.

According to International Classification Diseases of the tenth revision (ICD-10) The condition is assigned to the XIV class of "diseases of the urogenital system". The class is divided into 11 blocks. The designation of each block begins with the letter N. Each disease has a three-digit or four-digit designation. Inflammatory kidney diseases refer to references (N10-N16) and (N20-N23).

What is dangerous Nedug

1. Inflammatory kidney disease - common pathology. Sick can anyone. Risk group extensive: children, young women, pregnant women, older men.
2. Kidney - leading organism filter. During the day they skip up to 2,000 liters of blood. It is necessary to get sick, as they do not cope with filtering toxins. Toxic substances Again enroll in blood. They are distributed throughout the body and poison it.

The first symptoms are not immediately associated with kidney disease:

• Enhance arterial pressure.
• The appearance of itching.
• Edema extremities.
• Feeling fatigue inappropriate loads.

Treatment of symptoms without consultation with specialists, at home, leads to a deterioration in the state.

Deals may provoke any factors surrounding a modern person: stress, supercooling, overwork, weakened immunity, an unhealthy lifestyle.

Disease is dangerous to what can become chronic. In exacerbation, the pathological process applies to healthy sites. As a result, the parenchyma dies, the organ is gradually wrinkled. Its functioning is reduced.

The disease can lead to the formation renal failure And the need to connect the apparatus "Artificial kidney". In the future, kidney transplantation may be required.

Especially dangerous consequences - the accession of purulent infection, necrotization of the organ.

The ICD-10 indicates:

Acute pyelonephritis. Code N10

Acute inflammation caused by the infection of kidney tissues. More often affects one of the kidneys. It can develop both in healthy kidney, and flow against the background of the disease of the kidney, anomalies of development, or violation of urine derivation processes.

For identification infectious agent Extra code (B95-B98) is used: B95 - for streptococci and staphylococci, B96 - for other refined bacterial agents and B97 - for viral agents.

Chronic pyelonephritis. Code N11.

Usually develops due to non-compliance with the therapeutic regime of the acute state. As a rule, the patient knows about his illness, but sometimes she can flow latently. The symptoms expressed during the exacerbation gradually subside. And the impression is created that the disease retreated.

In most cases, pathology is detected during dispensarization, when analyzing urine due to other complaints (for example, high blood pressure) or diseases (for example, urolithiasis).

When collecting anamnesis, these patients sometimes identify the symptoms of transferred cystitis and other inflammatory diseases of the urinary tract. During exacerbations, patients complain about pain in lumbar region, small temperature, sweating, exhaustion, decay, reduction of appetite, dyspepsia, dry skin, increase pressure, pain during urination, reducing the amount of urine.

Allocate:

Nestructive chronic pyelonephritisRelated with reflux. Code N11.0..

Reflux - reverse current (in this context) urine from the bladder in ureters and higher. Main reasons:

• Overflow of the bladder.
• Stones bladder.
• Hypertonus bladder.
• Prostatitis.

Chronic obstructive pyelonephritis. Code N11.1.

Inflammation develops against the background of violation of urinary tract due to congenital or acquired developmental anomalies urine system. According to statistics, obstructive form is diagnosed in 80% of cases.

Non-Building Chronic Pyelonephritis BDU N11.8

With this pathology, ureterals are not blocked by concretions or microorganisms. The passability of urinary tract is preserved, urination is not impaired or quantitatively.

Pyelonephritis BDU. Code N12.

The diagnosis is made without additional clarifications (acute or chronic).

Calculosis pyelonephritis. Code N20.9.

Developed against the background of renal concrections. If you reveal the presence of stones and start treatment, then you can avoid chronic illness.

Stones can not give birth to years, so their diagnosis is difficult. The appearance of strong pain in the lumbar region means only one thing - it's time to turn to a qualified technician. It is sad that most patients reluctantly turn to doctors at the first symptoms of the disease.

From the foregoing it follows that this twig is a real chameleon among other pathologies. Cooked in his love to accept the kind of other diseases, it can end sadly. Listen to your body. Do not muffle pain and other symptoms by self-treatment. Contact promptly for help.

Pyelonephritis is one of the common kidney disease, which is striking mostly young people and middle-aged people. When pyelonephritis, inflammation of one or both kidneys is developing, which is most often a consequence of a bacterial infection.

Etiology and pathogenesis

Most often develops between the ages of 16 and 45. Women suffer from pyelonephritis much more often. Pyelonephritis may be associated with sexual activity in women. Genetics does not matter.

The disease may arise due to the penetration of bacteria in the urinary system through the urethra. Often bacteria spread from the focus of inflammation in the bladder. Infections of the urinary system, and, accordingly, pyelonephritis, are much more like women, because Their ureasual channel is shorter than male and its exit is located closer to the anal pass. Bacteria from anal passage can be entered into the urethra during sexual intercourse or if hygienic measures are incorrect after the act of defecation.

In both sexes, the pyelonephritis develops much more often if there is their physiological obstruction somewhere throughout the urinary tract, which creates an obstacle to normal urine outflows. In this case, the bacteria that are already kept in the urine are not flushed together with it from the body, as it happens in the norm. Instead, the process of their reproduction occurs in the stagnant urine. Physiological obstruction can be created as a result of the pressure being rendered on any part of the urinary system. Number possible causes The obstruction includes an increase in the uterus during, as well as in men. In addition, normal promotion may interfere or. In addition, kidney stones can serve as a refuge for bacteria, which can increase the sensitivity of patients with infectious diseases urinary system. All listed states with high degree The probabilities cause repeated attacks of pyelonephritis.

Diagnosis and treatment

Pyelonephritis usually manages to be clearly diagnosed and immediately proceed to its treatment, so it rarely ends with chronic kidney damage. In children, the symptoms of pyelonephritis is less obvious. As a result, its flow can pass unnoticed, which leads to a serious kidney damage.

Symptoms of pyelonephritis can develop unexpectedly, often within a few hours. The symptoms of pyelonephritis may include: severe pain, starting in the spin area directly above the waist, and propagating its lateral parts; temperature exceeding 38 ° C accompanied by chills and headache; Painful I. frequent urination; muddy urine with blood splashes; nasty smell urine; nausea and vomiting.

In case of suspected the development of pyelonephritis, it is necessary to analyze urine for the presence of infection. When traces of bacteria, the type of bacteria that caused infection should be determined. Men and children after a single case of pyelonephritis may need a further examination to eliminate the hidden disease (pyelonephritis is often found in the female). Further examination may include taking analyzes for testing kidney functions. Procedures such as ultrasound scans, computed tomography and intravenous urography can also be carried out in order to verify the presence of signs of kidney lesion or diseases such as.

Pyelonephritis is usually treated with the help of the course of antibiotics in oral form, the symptoms of the disease usually disappear after 2 days of treatment. After the end of treatment, additional blood tests can be taken to confirm the cure. But if the patient has vomiting, pain or serious malaise, he may be offered hospitalization, and intravenous fluid injections and antibiotics will be appointed in the hospital. If the pyelonephritis proceeds in the form of repeating attacks, it is recommended to take small doses of antibiotics for two years to reduce their frequency for two years.

In most cases, adequate treatment of pyelonephritis is effective, and the pyelonephritis does not cause irreversible kidney damage. Nevertheless, in rare cases, frequent pyelonephritis attacks can lead to the formation of fibrous tissue in the kidneys and, as a result, to their irreversible damage.

Urinary tract infection - This is an infection that occurs on any section of the urinary system - from perinephral fascia to the outer opening of the urethra. (Carolin P., Cacho M.D. 2001).

The infection of urinary tract (IPP) is classified as follows (EAU, 2008):

1. Type of pathogen (bacterial, fungal, mycobacterial);

2. Localization in urinary tract:

a) diseases of the lower urinary tract (urethritis, cystitis)

b) diseases of the upper urinary tract (acute and chronic pyelonephritis)

3. The presence of complications, Localization of imp and combinations:

a) uncomplicated infection of the lower departments of urinary tract (cystitis)

b) uncomplicated pyelonephritis

c) complicated imp with pyelonephritis or without pyelonephritis

d) Uruppsis

e) urethritis

e) special forms (prostatitis, orchitis, epidididimitis)

It is necessary to take into account age (elderly patients), the presence of concomitant diseases (including diabetes et al.), Immunity condition (immunocompromentized patients)

Uncomplicated impAs a rule, successfully treatable adequately selected antibacterial therapy.

Complicated imp It is more difficult to antimicrobial therapy and, in some cases, require the intervention of the urologist, since they can lead to severe mine-septic complications.

Classification of ICD 10.

N 10 - acute tubula-interstitial nephritis (includes acute pyelonephritis)

N 11.0 - chronic tubula-interstitial nephritis (includes unstructive chronic pyelonephritis, reflux-associated)

N 11.1 - Chronic obstructive pyelonephritis

N 11.8 - other chronic tubula-interstitial jade (includes the unstructive pyelonephritis)

N 11.9 - Chronic tubul-interstitial nephritis uncomfortable (includes unspected pyelonephritis)

N 12 - tubula-interstitial nephritis not defined as acute or chronic (includes pyelonephritis)

N 15.9 - Tubul-interstitial kidney disease Uncomfortable (includes the kidney infection unspected)

N 20.9 - Urinary stones Uncomfortable (calculous pyelonephritis)

N 30.0 - acute cystitis

N 30.1 - interstitial cystitis (chronic)

N 30.8 - Other Cystitis

N 30.9 - unspecified cystitis

N 39.0 - Urinary tract infection without localization

Diagnosis wording

In the formulation of the diagnosis, an international classification of reviews 10 reviews, indicating in chronic forms of the nature of the flow (recurrent, latent), phases of the disease (remission, aggravation) and kidney functions (stage of chronic kidney disease).

Given the generally accepted international terminology, as well as the fact of a often occurring common ascending infection and the difficulties of a clear definition of the localization of inflammation, it is advisable to use the term "urinary tract infection (IP).

We give examples of the wording of diagnoses and the corresponding ICB-10 codes:

MainDs.: Imp, chronic pyelonephritis, recurrent, aggravation, HBP 1 tbsp. (N 11.8)

MainDs.: Imp, acute right-sided pyelonephritis. (N 10) Complication: Paranephrites on the right.

MainDs.: Imp, sharp cystitis. (N 30.0)

Epidemiology

Urinary infection remains one of the important causes of diseases in various age groups. Imp It is quite widespread, about 7 million outpatient appeals, more than 1 million hospitalizations on Imp are annually registered. Economic costs make up more than one billion dollars. 20-50% of women tolerate Impat least once in life. Risk Imp Women are more susceptible, but the risk increases with age Imp and its complicated flow and women, and in men (IDSA. 2001). In Russia, the most frequent urinary tract disease is acute cystitis (OC) - 26-36 million cases per year, and men have only 68 episodes at 10,000 aged 21-50 years. Acute pyelonephritis (OP) is also more common in women, and in all age groups. The frequency of the OP is significantly higher than the OC and is 0.9 - 1.3 million cases annually. In women, the risk of PM is 30 times higher than in men, including in connection with a pregnancy from 4-10%. In postmenopausis Imp develops in 20% of patients. The incidence of urkutsk diseases of urinary tract in 2007 amounted to 6022 per 100,000 adults,

and mortality - 8 per 100,000 permanent population

Currently identified the main at-risk groups, clinical formsThe diagnostic criteria of implies have developed effective ways to control infection in complicated and uncomplicated cases, including in risk groups.

Character and severity clinical manifestations The OIN depends on the severity of the general intoxication of the body and on the degree of activity of the pathological process in the kidneys. The first subjective symptoms of the disease usually appear in 2-3 days from the start of treatment with antibiotics (most often with penicillin or semi-synthetic analogs) by geovo aggravation chronic tonsillita, Angina, Otita, Schimorita, ORVI and other diseases preceding the development of the OIN. In other cases, they arise a few days after the appointment of nonsteroidal anti-inflammatory funds, diuretics, cytostatics, radiocontrase substances, sera, vaccines. Most patients have complaints about general weakness, sweating, headache, painful pain in the lumbar region, drowsiness, decrease or loss of appetite, nausea. Often, the mentioned symptoms are accompanied by a chill with fever, fragile in muscles, sometimes with polyartralgia, skin allergic rashes. In some cases, the development of moderately pronounced and short arterial hypertension. Evenkers for OIN are not characteristic and, as a rule, are absent. Not usually observed dysuric phenomena. In the overwhelming majority of cases, from the first days there is a polyuria with a low relative density of urine (hypoxenuria). Only with very severe course Oin at the beginning of the disease there is a significant decrease (Oliguria) of urine up to the development of Anururia (combined, however, with hypoxenuria) and other signs of OPN. At the same time, the urinary syndrome is revealed: minor (0.033-0.33 g / l) or (less often) moderately pronounced (from 1.0 to 3.0 g / l) proteinuria, microhematuria, small or moderate leukocyturia, cylindruria with the predominance of hyaline, And with severe flow - and the appearance of grainy and wax cylinders. Oxalaturia and calciumuria are often detected.
The origin of proteinuria is primarily connected with a decrease in the reabsorption of protein by the epithelium proximal departments Channels, however, the possibility of secretion of a special (specific) tissue protein Tamm-Horsfall in the lumen of the Channels (B. I. Shulutko, 1983) is not excluded.
The mechanism of the occurrence of microhematuria is not entirely clear.
Pathological changes in the urine are maintained throughout the disease (within 2-4-8 weeks). Especially long (up to 2-3 months or more) is the polyuria and hypoxenuria. Observing sometimes in the first days of the disease, oliginia is associated with an increase in intra-bank and intra-capsular pressure, which leads to a drop in effective filtration pressure and the transient reduction in glomerular filtration rate. Along with a decrease in the concentration ability (also in the first days), a violation of the nominality of the kidneys (especially in severe cases) is developing, which is manifested by hyperasotemia, i.e., an increase in the blood level of urea and creatinine. It is characteristic that hyperazotemia develops against the background of polyuria and hypostenuria. Perhaps also disorder electrolyte balance (hypokalemia, hypongatremia, hypochloride) and acid-alkaline equilibrium with acidis phenomena. The severity of the mentioned kidney disorders in the regulation of nitrogenous balance, acid-alkaline equilibrium and water-electrolyte homeostasis depends on the severity of the pathological process in the kidneys and achieves the greatest extent in the event of the development of the OPN.
Consequently inflammatory process In kidneys and general intoxication, characteristic changes from peripheral blood are observed: a small or moderate leukocytosis with a slight shift to the left, often - eosinophilia, an increase in ESO. In severe cases, anemia is possible. With a biochemical study of blood, a C-jet protein is detected, elevated indicators of DFA tests, sialic acids, fibrinogen (or fibrin), disproteinemia with hyper-A1 and A2-glusulinemia.
When evaluating clinical picture Oin and his diagnosis is important to keep in mind that almost almost in all cases and already in the first days of the beginning of the disease, signs of renal failure are developing various degrees severity: from a minor increase in blood levels of urea and creatinine (in light cases) to a typical painting of OPN (with severe flow). It is characteristic that the development of Anururia (severe Oliguria) is possible, but not necessarily. More often renal failure develops against the background of polyuria and hypoxenuria.
In the overwhelming majority, the phenomena of renal failure are reversible and pass in 2-3 weeks, but the disruption of the concentration function of the kidneys is preserved, as already noted, for 2-3 months and more (sometimes up to year).
Taking into account the characteristics of the clinical picture of the disease and its flow, the following options (forms) of the Oin are distinguished (B. I. Shulutko, 1981).
1. The detailed form for which all listed above is characteristic clinical symptoms and laboratory signs of this disease.
2. The ONIN version flowing according to the type "banal" (ordinary) OPN with long-term Anuria and increasing hyperazotemia, with the phasinity of the pathological process characteristic of the Phaznost and its very difficult flow requiring the use of acute hemodialysis.
3. The "abortive" form with the lack of phase of Anururia characteristic, the early development of polyuria, insignificant and short hyperazotemia, favorable flow and rapid recovery Azovetative and concentration (within 1-1.5 months) kidney functions.
4. The "focal" form at which the clinical symptoms of the OIN are expressed weakly, erased, changes in the urine are minimal and non-permanent, hyperazotemia is either absent or minor and rapidly transient. For this form, a sharply arising polyurium with hypoxenuria, fast (within a month), the restoration of the concentration function of the kidneys and the disappearance of pathological changes in the urine is more characteristic. This is the easiest way and most favorable ONIN option. In the clinical conditions, it usually passes as "infectious-toxic kidney".
Under the OIN, the forecast is most often favorable. Usually the disappearance of the main clinic-laboratory symptoms of the disease occurs in the first 2-4 weeks from its start. During this period, urine and peripheral blood indicators are normalized, restored normal level Urea and creatinine in the blood, the polyuria with hypoxenuria (sometimes up to 2-3 months or more) is significantly longer. Only in rare cases with a very serious course of the OIN with pronounced phenomena, an unfavorable outcome is possible. Sometimes Oin can acquire chronic flowmainly at the late diagnosis and improper treatment, non-compliance with patients with medical recommendations.