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MANIFESTATIONS OF EXACERBATION OF CHRONIC PYELONEPHRITIS IN
PREGNANT WOMEN
Rajabova Oygul Islomovna
Asian International University.
https://doi.org/10.5281/zenodo.15081591
Abstract.
This article reviews the manifestations of exacerbation of chronic
pyelonephritis in pregnant women.
Keywords:
kidney, calyces, chronic pyelonephritis, interstitial renal tissue, hypertensive
disorders, Pasternadsky's symptom, albuminuria, antianemic treatment.
ПРОЯВЛЕНИЯ ОБОСТРЕНИЯ ХРОНИЧЕСКОГО ПИЕЛОНЕФРИТА У
БЕРЕМЕННЫХ
Аннотация.
В статье рассматриваются проявления обострения хронического
пиелонефрита у беременных.
Ключевые слова:
почки, чашечки, хронический пиелонефрит, интерстициальная
ткань почек, гипертензивные расстройства, симптом Пастернадского, альбуминурия,
антианемическое лечение.
Relevance.
Chronic pyelonephritis is a sluggish pathology of inflammatory-infectious
genesis, affecting the structures of the kidney that regulate the outflow of urine, interstitial renal
tissue, renal pelvis and calyces, with subsequent sclerosis of the parenchyma and shrinkage of
the kidney. According to the authors Bragina T.V. et al. (2021), kidney pathology ranks second in
the structure of extragenital pathology, which leads to complicated pregnancy, childbirth, and the
postpartum period. As Djaitanbekova E.K. points out in her prospective study. (2020) one of the
pressing problems of modern obstetrics is inflammatory kidney disease, which has a negative
impact on the reproductive function of a woman, complicating the course of pregnancy and
childbirth in approximately 6% of women on average, which is manifested by the development
of hypertensive disorders, miscarriage, premature birth of children, an increased frequency of
postpartum renal and extrarenal complications. The same data are given in their study by
Antonova M. L., Paramonova T. K., Dallakyan V. V. (2018), noting that this is the most
dangerous concomitant disease in pregnant women and negatively affects perinatal and maternal
mortality rates. The inflammatory process can be observed at all stages of the gestational period,
that is, during pregnancy, childbirth and the postpartum period.
Objective:
To study the course of pregnancy in a patient with exacerbation of chronic
pyelonephritis and to determine risk factors for complications of pregnancy and childbirth.
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Materials and methods. The materials of the work were the data of patient M., born in
1997, who was admitted to the maternity ward of the Clinic No. 1 of the Bukhara State Medical
Institute in the third trimester of pregnancy with complaints of pain in the lower back, in the
abdominal area, radiating down the abdomen, headaches, an increase in div temperature to 38.5
C. The research methods were a complete clinical and laboratory examination and Doppler
sonography of the fetus.
Results and discussions.
According to the anamnesis of the disease, the woman
considers herself ill for several years, periodically received treatment in the urology department
of the city hospital for pyelonephritis, the disease is not associated with anything. Before
admission, she was treated at home on her own for 3 days, since her condition did not improve,
she went to the clinic of the Bukhara State Medical University No. 1. The patient has a history of
frequent cases of acute respiratory infections and acute respiratory viral infections. She has not
received any injuries.
Among gynecological diseases, she notes the presence of cytomegalovirus infection and
herpes virus, for which she received treatment during pre-pregnancy preparation. According to
the patient, she has no bad habits (drinking alcoholic beverages, tobacco products, salty, bitter
and frequent caffeine consumption). Her diet is regular and nutritious. Heredity, epidemiological
and allergic history are unremarkable. She takes NSAIDs several times a month, during an attack
of pain in the lumbar region on the right. Objectively: the condition is satisfactory, consciousness
is clear. The skin is pale pink. Percussion sound over the entire surface of the lungs is clear
pulmonary.
On auscultation: vesicular breathing. RR = 19/min. Heart sounds are muffled, rhythmic.
HR = 82/min. BP = 130/80 mmHg on both arms. The abdomen is soft and painless on
palpation, enlarged due to pregnancy and corresponds to the gestational age. The liver does not
protrude from under the costal margin, the edge is smooth, elastic, painless. The spleen is not
palpable.
Pasternadsky's symptom is positive on the right. Diuresis is preserved. Edema of the legs.
A general blood test shows signs of inflammation (leukocytes 9.1 * 10 ^ 12 / l, ESR - 36 mm /
h), anemia (hemoglobin 74 g / l, erythrocytes 3.1 * 10 ^ 12 / l, CI 0.8). Urine analysis reveals
albuminuria (MALB- 30 mg / L), leukocyturia (5-7-9). Biochemical blood analysis indicates an
increase in AST and ALT, and total protein was also reduced. Due to the patient's pregnancy,
radiation diagnostic methods are excluded and the main instrumental method remains ultrasound,
which simultaneously makes it possible to check both the patient and the fetus. Kidney
ultrasound data: Signs of urinary tract obstruction are not detected, topographically, the kidneys
are displaced upward, compression is observed.
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Contours are smooth, the capsule is traced along the entire length, 2 mm thick,
hyperechoic. The thickness of the renal parenchyma is 11-12 mm. The parenchyma is
homogeneous, granular. The renal pelvis is dilated, not deformed. According to fetal Doppler
sonography: Pregnancy is 35 weeks, fetoplacental blood flow disorders are not detected. Single
umbilical cord entanglement around the fetal neck. Hypertonicity of the uterus.
The following treatment was prescribed: Diet table No. 7, anti-inflammatory therapy
(NSAIDs), antibiotic therapy (according to sensitivity), infusion therapy (reosorbilact),
monitoring of diuresis, blood pressure and fetal condition. It is worth noting that penicillin
antibiotics did not give an effect in the patient, after which cephalosporins were prescribed. The
patient noted a decrease in div temperature during treatment the next day after admission, the
general condition improved. With good treatment dynamics, blood pressure decreased. The
pregnancy was prolonged. Dispensary registration at the place of residence, antianemic treatment
are recommended.
Conclusion and findings.
Thus, based on the case, it can be concluded that timely
treatment can prevent the development of further complications, which is important for the
mother and child. With the help of early diagnosis of the disease, the correct treatment plan and
prognosis will be prescribed in time, which will allow prolonging the pregnancy.
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