Introduction

Changes in urodynamics that occur during pregnancy are due to the effect of progesterone on the muscular tonus of the ureters and their mechanical obstruction by the growing uterus. Factors contributing to the development of urinary tract infections during pregnancy:

expansion of renal pelvis and upper ureteral regions with the formation of physiological hydronephrosis in pregnant women;

a decrease in the tone of the bladder, an increase in the amount of residual urine, which contributes to vesicoureteral reflux and ascending migration of bacteria to the upper sections of the urinary tract;

changes in physico-chemical properties of urine that promote bacterial growth (increase in pH, estrogen concentration, glucosuria),

weakening of the sphincter of the urethra (towards the end of pregnancy);

Increase in renal blood flow by 50-80% in the I trimester with a gradual decrease), an increase in glomerular filtration by 50%, tubular reabsorption is constant

 Pyelonephritis is an infectious-inflammatory disease of the kidneys with a predominant lesion of the interstitial tissue and the bowl-and-pelvis system.

Gestational pyelonephritis is pyelonephritis, first detected during pregnancy. In the structure of extragenital pathology in pregnant women and puerperas, its frequency reaches 10% and higher.

 

 Pathogens of gestational pyelonephritis in 57-65% of microorganisms of the enterobacteria group (E. coli 39%, Klebsiella, Proteus) and enterococcus (10-23%), Klebsiella, Staphylococcus, Pseudomonas aeruginosa, streptococcus, fungi.

Classification:

 -On pathogenesis: primary; secondary.

-According to the nature of the current: acute; chronic (latent or recurrent).

-By period: exacerbation (active); reverse development of symptoms (partial remission); remission (clinical and laboratory).

-On the safety of kidney function: without impaired renal function; with impaired renal function.

The side with more pronounced clinical manifestations: left; right; Both kidneys are equally affected.

The main ways of spreading the infection are hematogenous and urogenital (ascending) from the urethra and the bladder through the ureter into the pelvis.

Risk factors for gestational pyelonephritis:

previous infections of the urinary tract; malformations of the kidneys and urinary tract; urolithiasis disease; inflammatory diseases of female genital organs, especially colpitis; bacterial vaginosis; carrier of pathogenic and conditionally pathogenic microflora; low socioeconomic status; diabetes; disturbances of urodynamics caused by pregnancy.

Clinic: intoxication: high temperature, severe headache, accompanied by an aching all over the body, nausea, vomiting, profuse sweating, breathing and pulse are frequent, the tongue is dry.

Local symptoms: • pain in the lumbar region, with irradiation of pain in the upper abdomen, inguinal region, large labia, thigh, in the course of the ureter, strengthening at night, with deep inspiration, coughing, a positive symptom of Pasternatsky

Diagnosis of pyelonephritis: clinical observation, laboratory, ultrasound (ultrasound of the kidneys, abdominal cavity), endoscopic studies.

  METHODS OF RESEARCH

• General blood test: leukocytosis, neutrophil shift of the leukocyte formula to the left due to an increase in stab-shaped forms; increased SDE, hypochromic anemia,

• Biochemical blood test: hypoproteinemia, dysproteinemia, with acute pyelonephritis increase serum urea levels.

      Examination of urine.

• General analysis of urine: leukocyturia (pyuria) + bacteriuria, flakes, cloudy urine  the appearance of cylinders - indicates the defeat of the kidney parenchyma.

• Urine analysis for Nechiporenko - leukocyturia (normal ratio of leukocytes and erythrocytes 2: 1 (in 1 ml of urine 4000 leukocytes and 2000 erythrocytes).

• In the urine according to Zimnitsky - decrease in relative density and disruption of the ratio of diurnal and night diuresis, hypostenuria (in 56% of women)

• Reberg's test (reduction of reabsorption in severe forms);

• Urine culture on the flora and sensitivity to antibiotics.

 Complications of pregnancy:

• threat of interruption and premature birth -25% of women;

• toxicosis of the second half of pregnancy (gestosis) 40-80%;

• Anemia 33%;

• intrauterine hypoxia, fetal hypotrophy;

• intrauterine infection of the fetus;

• acute renal failure,

• septicemia, septicopyemia.

General principles of management of pregnancy, childbirth, the postpartum period in women with kidney disease.

The timing of pyelonephritis.

• During pregnancy at 22-28 weeks (maximum corticosteroid elevation).

• At 32-34 weeks, when the uterus reaches its maximum in size

• 39-40 weeks - the head is pressed to the entrance to the small pelvis.

• After childbirth - 2-5 days, 10-12 days.

Pregnant women with kidney diseases are subject to double dispensary supervision by an obstetrician-gynecologist and a female consultation therapist;consultation of urologist, nephrologist according to indications.

Clinical examination consists in conducting the appropriate examination and preventive treatment: • General urine analysis - at each turnout, but at least 1-2 times a month, • a general blood test -1 times a month; •