Pyelonephritis and glomerulonephritis comparison and how they differ

pyelonephritis

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What is it

With the penetration of infection into the kidney, inflammation of the pyelocaliceal formations develops with the involvement of the renal parenchyma in the process. This is called pyelonephritis. At a young age, pathology often occurs in women, manifesting itself mainly as a complication of other diseases of the urinary organs. Often, pyelonephritis is triggered by pregnancy.

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Men get sick mainly in old age, which is a consequence of prostate adenoma.

Distinguish with the flow:

  • Acute.
  • Chronic.

By consequence of occurrence:

  • Primary (no association with other urinary tract infections)
  • Secondary, arising as a complication of urological diseases that disrupt the dynamics of urine. Refers to the most common option.
    • One-sided (most often)
    • Double sided.

    Causes

    Causes of pyelonephritis infection. The main causative agents of the disease are microorganisms: E. coli, staphylococcus, enterococcus, streptococcus. Rarely viruses, fungi.

    The painful pathogen penetrates into the organ:

    • Ascending route (with existing cystitis, urethritis)
    • Hematogenous and lymphogenous (carried by blood from other infected foci in the body.

    Contribute to the onset of the disease:

  • Violation of urine discharge due to pressure on the urinary tract from the outside, changes in the lumen of the ureter, urinary stones, prolapse of the kidneys.
  • Decreased immunity due to previous infections, exposure to low and high temperatures, stress, overwork, lack of vitamins.
  • Disruption of lymphatic and venous drainage from the kidney,
  • Concomitant diseases: diabetes, gout.

    Symptoms

    Typical pyelonephritis has a fairly characteristic clinical picture and its symptoms are as follows:

    • Pain in the lumbar region of the back from moderate to severe, having the character of renal colic.
    • As a rule, high body temperature with attacks of chills, heavy sweating,
    • Discoloration, clarity and odor of urine.
    • Pain in the head and muscles.
    • Decreased amount of urine, painful, frequent urination,
    • Thirst, frailty.

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    Diagnostics

    In addition to typical complaints, laboratory data are analyzed to confirm the diagnosis:

    • The urine contains a large number of bacteria, leukocytes, microhematuria, there may be a small amount of protein.
    • In the blood, an increase in leukocytes, a sharp neutrophilia, an increase in ESR.

    Ultrasound is characterized by an increase in the affected kidney, a hypoechoic zone of the parenchyma (due to inflammatory edema), expansion of the renal pelvic structures.

    An excretory urogram shows either a slow filling of the inflamed side with a contrast agent, or the absence of a shadow of the urinary tract.

    On MRI, pyelonephritis looks like hyperintense areas in the affected area.

    Treatment

    Given that pyelonephritis is an infectious disease, antibacterial drugs are of paramount importance. A urine culture is done, which determines the effect on the pathogen of the desired antibiotic. Without waiting for the seeding result, broad-spectrum antibiotics are introduced:

    • Fluoroquinolones (ciprofloxacin, norfloxacin)
    • Aminopenicillins (amoxiclav)
    • Cephalosporins (cefotaxime, cefaclor)
    • Aminoglycosides (gentamicin, amikacin)

    To relieve pain and spasms are used:

    • Antispasmodics (no-shpa, spazmalgon),
    • Non-specific anti-inflammatory drugs (indomethacin, nimesulide).

    To improve the outflow of urine, to relieve inflammation as soon as possible, therapy is supplemented with medicinal herbs (lingonberry leaf, kidney collection) or ready-made preparations (cyston, kanephron).

    A large amount of fluids, bed rest, diet are recommended.

    glomerulonephritis

    What is it

    Glomerulonephritis is an immune inflammation with a predominant lesion of the glomerular apparatus of both kidneys. It can develop at any age, but most before 40 years.

    There are various morphological and clinical forms of glomerulonephritis, types of course that determine the severity and outcome of the disease.

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    Causes

    There are 2 main groups of reasons:

  • Immuno-infectious (hemolytic streptococcus, pneumococcus, staphylococcus, viruses)
  • Immune-non-infectious (serum, vaccines, ethanol, drugs).

    Toxins damage the basement membrane of the glomerular capillaries, which provokes the appearance of autoantigens. In response, anti-kidney antibodies (IgG and IgM) are produced. Under unfavorable conditions for the body (hypothermia, trauma, stress), a violent allergic reaction is formed (fusion of an antigen with an antibody). As a result, immune complexes are formed, which are fixed in the glomeruli of the kidney and trigger a chain of immune inflammation.

    Symptoms

    The most typical manifestations are edema syndrome, hypertension and urinary syndromes.

    Patients complain of heaviness in the lower back on both sides, headache, fever, decrease in the amount and color of urine (reddish, brown, cloudy), shortness of breath.

    Swelling occurs on the face in the morning, combined with pallor of the skin. The pressure rises moderately. Cardiovascular and brain disorders are quite common. As an extreme option, cardiovascular failure, angiospastic encephalopathy.

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    Diagnostics

    Diagnostics is carried out on the basis of complaints, additional studies.

    • In urine tests: protein, casts, erythrocytes, a small number of leukocytes.
    • In the blood: decreased hemoglobin, increased ESR, increased fibrinogen, alpha2 and gamma globulins, sialic acids, C-reactive protein.

    On ultrasound, the kidneys are not enlarged, the variegation of the parenchyma zone is manifested (alternation of dense and less dense areas).

    A biopsy can confirm the diagnosis and determine the morphological form of glomerulonephritis.

    Treatment

    The mainstay of treatment for glomerulonephritis is suppression of immune inflammation. For this purpose, the following are used:

    • Glucocorticoid (prednisone)
    • Cytostatics (cyclophosphamide, azathiopyrine)
    • Selective immunosuppressants (tacrolimus).

    To reduce fibrinolysis:

    • Anticoagulants (heparin)
    • Antiplatelet agents (dipyridomol).

    Symptom-controlled therapy includes:

  • Antihypertensive drugs (enalapril)
  • Diuretics (furosemide)
  • Statins (atomax)

    It is necessary to follow a diet (exclusion of spicy, salty foods), bed rest.

    Comparison of pyelonephritis and glomerulonephritis

    The main criteria for distinguishing between two renal pathologies are:

  • The cause of the inflammation (pyelonephritis, infection damage, glomerulonephritis, immune damage), respectively, a different approach to therapy.
  • Primary involvement of renal structures in the painful process (pyelonephritis of the calyx-pelvic system, glomerulonephritis, glomerular apparatus)
  • Symmetry of the process (pyelonephritis is one-sided, glomerulonephritis is bilateral)
  • The severity of the pain component (typical for pyelonephritis)
  • Concomitant pathology of the urinary system (often found in pyelonephritis)
  • Protein and erythrocytes in urine (mainly with glomerulonephritis)
  • Increased pressure (more often with glomerulonephritis)
  • Edema (with glomerulonephritis already in the initial stage)

    The similarity of both diseases is that with the progression of the process, renal function is impaired, and this leads to the same outcome of renal failure.

  • Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

    He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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