1. Cycle: "NEPHOLOGY"
Амалий машғулот №2
Subject: "Dysuria. The differential diagnosis of acute and chronic pyelonephritis. Tactics GPs. Indication for a referral to a specialist or hospitalization profile department. Principles treatment, follow-up, monitoring and rehabilitation in RHU or family policlinics. Principles of prevention».

2. The purpose of the training session:
Getting GPs on timely diagnosis and differential diagnosis of pyelonephritis. The clinical course and the principles of management of patients in primary care, provided the requirements of the "Qualification characteristics of the general practitioner."

3. Pedagogical objectives:
GPs familiarize with the list of diseases associated with pyelonephritis and to be treated in the FCP (FP) or specialized hospitals.
Teach GPs diagnose pilonefritov.
Discuss questions about tactics in the qualifying characteristics of GPs
Discuss the principles of treatment (non-drug and drug).
Discuss the principles of management, supervision and monitoring of patients in rural health units or family policlinics.
Discuss the principles of primary, secondary and tertiary prevention in these diseases.

4. GPs should be aware of: The mechanism of pyelonephritis
Differential diagnosis of pyelonephritis
The principles of treatment (drug and non- drug) for these diseases.
Principles of follow-up and monitoring of patients in a rural health units, or family policlinics.
The principles of primary, secondary and tertiary prevention in these diseases.

5. GPs should be able to:
Diagnose, to differentiate on clinical and laboratory-instrumental data pyelonephritis
Choose products with proven efficacy
Advise on non-medicated treatments.
To monitor the RHU or in family policlinics.

6. GPs should do:
Data analysis and history of complaints to diagnose pyelonephritis
Interpret the results of laboratory data instumentalnyh pyelonephritis.
Prescribe medication and perform clinical examination of patients with pyelonephritis
The list of skills that GPs should possess after completing studies on the subject
Conduct a survey of patients with pyelonephritis
The interpretation of laboratory and instrumental data of patients with pyelonephritis

7. Pyelonephritis

8. Pyelonephritis - nonspecific infectious kidney disease that affects the renal parenchyma,
mainly interstitial tissue, pelvis and calyx.
Pyelonephritis can be one-and two-way and secondary, acute (serous or purulent), chronic or recurrent.

9. Etiology and pathogenesis.
Most often caused by intestinal Escherichia pyelonephritis (75%), enteritisofcocci, Proteus (10-15%), staphylococci, streptococci. 1 / 3 of patients acute pyelonephritis and 2/3 of patients with chronic pyelonephritis is a mixed flora. During treatment, the microflora and its sensitivity to antibiotics and change that requires repeated urine culture to determine adequate uroantiseptics. It must be remembered as recovery and L-form bacteria in the recurrences of pyelonephritis. If the infection in the kidney supported, the urine culture does not detect them. Development of pyelonephritis is largely dependent on the total with microorganism, reducing immuno-reactivity. Infection enters the kidney, pelvis and calyx hematogenous or lymphatic path of the lower urinary tract on the wall of the ureter, in his ray of lightin the presence of ETU-retrograde. Important in the development of pyelonephritis have stasis of urine, impaired venous and lymphatic drainage of the kidney.
Acute pyelonephritis is interstitial, serous or purulent.

10. Symptoms within.
Disease begins acutely, there are high (up to 40 ° C) temperature, chills, sweat, pain in the lumbar region on the side of the expressions on the kidney-tension abdominal wall, sharp pain in the costovertebral angle, malaise, thirst, dysuria or pollakiuria. Added headache, nausea, vomiting indicate rapidly increasing intoxication. Marked neutrophilic leukocytosis, aneozinophilia, piuria with moderate proteinuria and hematuria. Sometimes, when the deterioration of the leukocytosis followed by leukopenia, which is a bad prognostic sign. Sign of Pasternatskiy usually is positive. With bilateral acute pyelonephritis often show signs of kidney failure.
Acute pyelonephritis can paranephritis, necrosis of the renal papillae.

12. Diagnosis.
Important role in the diagnosis of a history play instructions on recent acute purulent process or the presence of chronic disease (subacute bacterial endocarditis, gynecological diseases et al.). Characterized by a combination of fever with dysuria, pain in the lumbar region, oliguria, piuria, proteinuria, hematuria, high relative density of urine. Keep in mind that pathologic elements in the urine may occur with any acute suppurative disease and that can have piuria origin (prostate, lower urinary tract).

13. Chronic pyelonephritis
may be due to untreated acute pyelonephritis (often), or primary, but chronic, can occur without acute symptoms of illness. Most patients with chronic pyelonephritis occurs in children, especially girls ge.U1 / 3 of the patients in the normal examination fails to identify the unmistakable signs of pyolonephritis.Often, only the periods of unexplained fever indicate a worsening of the disease. In recent years more and more frequent cases of the disease combined with chronic glomerulonephritis and pyolonephritis. Symptoms within. Unilateral chronic pyelonephritis is characterized by a dull no constant pain in the lumbar region on the side of the affected kidney. Disuria phenomenon, most patients are not available. In exacerbation only 20% of patients the temperature rises. As determined by the prevalence of urinary sediment of lymphocytes over other formed elements of urine.

14. Treatment. In the acute period prescribed table number 7a, the consumption of up to liters of fluid per day. Then, with the growing diet, increasing its content of protein and fat.

15. thank you for attention