Chronic pyelonephritis: symptoms and treatment in adults and children

Kidney stones are a very common and widespread problem in society, since, unfortunately, in the modern world the water supply, ecology and quality of food are spoiled. Very often there is a complication leading to a serious illness, such as chronic pyelonephritis. The formation of stones and all serious consequences are usually cured surgically, which in some cases can turn a person into a disabled person. In this article, we will look at when disability appears after removal of stones and pyelonephritis.

Basic conditions for recognition of disability

The formation of stones and all serious consequences are usually cured surgically, which in some cases can turn a person into a disabled person.
To assign disability, there are a number of norms and conditions, under which a person is assigned to the group with limited abilities. Its assignment is made in the following situations:

• If, after an illness or surgical intervention, disturbances in the functional characteristics of the body important for life are noticed;
• In the case where there are some impairments in the ability to care for oneself, move in space, learn, work, and so on;
• When a person needs social protection and rehabilitation;

Attention! If all of the above conditions are present, the commission must assign a disabled degree.

There are situations when the kidney cannot be saved, so it is removed. Most often, after this, the status of a disabled person is assigned for 1 calendar year. This degree belongs to the 2nd and 3rd groups. If a person has very severe complications, then group 1 is diagnosed. As soon as the period for which the assigned category expires, you must undergo the diagnosis again.

Despite the fact that the immunodeficiency virus is an incurable disease, those infected with this diagnosis can live a normal life for a long time. That is why HIV patients in the initial stages of development of the disease are not assigned a disability group. The fact is that this disease has several stages. The very first ones are incubation and acute. From the moment of infection , the incubation period lasts . The virus cells are already in the body, but in insufficient quantities to detect and cause damage to the body. An increase in their concentration leads to the appearance of the first symptoms . Is it possible to get disability due to HIV infection during this period? The answer to this question is negative. Yes, the acute stage of the disease is extremely unpleasant. It is characterized by fever, upset stomach, weakness and sudden weight loss. The symptoms are painful, but not fatal. An HIV patient does not need disability at this time. In addition, the acute period lasts from several weeks to several months, after which improvement occurs. The next stage is latent . It occurs without symptoms. The vast majority of those infected have already been diagnosed by this point. Is a disability group given for HIV infection during the asymptomatic stage ? No, it is impossible to get it at this moment.

The fact is that thanks to modern medicine, the asymptomatic stage can last for many years. In this case, HIV-infected people do not need disability. After all, the only thing that can cause a patient’s inability to attend work is a psychological barrier, which can be overcome with the help of a specialist. In addition, there is no article in Russian legislation according to which an infected person can be prevented from finding a job. AIDS is also not a reason for dismissal. And such actions by an employer towards an infected person are illegal.

However, the answer to the question of whether HIV disability is given in the asymptomatic period may be positive . However, we are talking about cases where, in addition to the immunodeficiency virus, a person has other serious health problems. But the virus is not an aggravating circumstance for obtaining disability due to HIV infection, since at this stage it does not cause deterioration in well-being.

You can get more detailed information about registering disability in office 128, which is open from 8-00 to 15-42 every day, except Saturday and Sunday (technical break from 12-00 to 12-30). The specialists of this office will be happy to provide detailed advice on all questions that interest you (not only on disability, but also other issues of a social nature: employment, restoration of documents (consultation), legal assistance (violations of your rights) and other problems and issues of a social nature) We are waiting Room 128 for your consultation!

List of basic documents for disability

The process of registering a group for a disabled person is quite long, so you should know in advance what official documents will be useful for this.
The process of registering a group for a disabled person is quite long, so you should know in advance what official documents will be useful for this:

Symptoms of drug-induced kidney damage and treatment

• Application to the ITU commission requesting the assignment of disability;
• Passport and its copies;
• Medical referral for commission;
• An extract from the hospital about the person’s condition and health;
• Other medical certificates;
• Results of diagnostic examinations;
• A copy of the work record;
• Certificate from place of employment: study, work;
• Pensioner's certificate.

After the certificate of disability is issued, you need to go to the social security authorities and apply for a pension. Its size will be based on the group and additional benefits. If you are denied disability, you have the right to challenge the decision.

Features of chronic pyelonephritis

Typically, the pathology occurs as a result of a localization process in the interstitial tissue
. Chronic pyelonephritis is a problem that often affects both children and adults. The disease is an infectious type of inflammation. Typically, pathology occurs due to a localization process in interstitial tissue. It is worth noting that the cup-scapular system is also affected.

Attention! Most often, this disease is observed in men over 50 years of age. Women predominate in statistics under 40 years of age.

The main reason for the appearance of this disease is gram-negative flora, which, with prolonged development, forms an association of microbes. Among the factors contributing to the development of the disease are the following:

• General characteristics and health status of the child and adult;
• In case of local causes of urodynamic disorders;
• Various infectious diseases that destabilize the functioning of the genitourinary system.

If the passage of urinary secretions is disrupted, the infectious component can move further throughout the body, for example, into the lower genitourinary tract, and even into the interstitial renal tissue.

Causes of prolapsed kidney: symptoms and treatment

Existing disability criteria

The first group is considered the most difficult, and it is assigned in such situations if a person cannot exist without additional help.
Today, three groups of disability are known. In this section, we will get to know them in more detail. The third category is assigned to such people:

• If a person is diagnosed with chronic pyelonephritis and works in industries with moderate to high levels of physical activity. In such situations, people need easier work, so when assigned to a group, they must be transferred to other work conditions.
• If a person works in the field of mental or physical activity, but suffers from chronic pyelonephritis or has stable arterial hypertension, then he needs another job, or a reduction in workload.
• If there are complications of pyelonephritis, for example, stage PA stage chronic renal failure, and employment in a position with high mental or physical stress, disability group 3 is assigned.

As for the second group, this is a more severe stage, for example, it is assigned in the following circumstances:

• At the stage of chronic renal failure, chronic pyelonephritis;
• If, in the presence of a disease, complications of blood circulation in the brain are observed, for example, due to secondary blood pressure with a complicated course;
• If a child or adult experiences extrarenal complications.

The first group is considered the most difficult, and it is assigned in the following situations:

• Stage CRF ShB refers to the 1st stage of disability;
• If there is stage 3 HF, stroke, anemia and other problems that arise in severe extra-real complications of the disease.
• If a person cannot exist without additional help.

So we looked at all the conditions when disability is assigned to people after removing kidney stones or suffering from chronic pyelonephritis.

Medical and social examination

Medical and social examination and disability in chronic pyelonephritis CHRONIC PYELONEPHRITIS DEFINITION Pyelonephritis is an inflammatory disease of the kidneys (or one kidney) of infectious origin with a predominant localization of the pathological process in the interstitial tissue and obligatory damage to the pyelocaliceal system. EPIDEMIOLOGY The annual incidence ranges from 0.5 to 3% in Southeast Asia, and approaches 1% in Europe. As a cause of death, chronic pyelonephritis is registered in 2.4-2.8 cases per 100,000 population. Under the age of 40, women are 3 times more likely to get sick; over 50 years, men predominate. ETIOPATHOGENESIS The cause of chronic pyelonephritis is predominantly gram-negative flora; with a long-term process, microbial association is possible. The following factors are important in the pathogenesis of chronic pyelonephritis: a) general condition of the body; b) urodynamic disturbances due to local causes; c) diseases that contribute to the development of urinary tract infections (diabetes, polycystic kidney disease, etc.). In conditions of impaired urine passage, the infection can spread from the lower parts of the urinary tract in the proximal direction up to the pelvis and interstitial tissue of the kidney. Factors predisposing to the onset and progression of the disease. The most important are: a) disturbance of urodynamics (urethral stricture, stones, prostate adenoma); b) conducting instrumental studies (catheterization); c) tropism for infection (tuberculosis, diabetes mellitus, hypovitaminosis, alcoholism, etc.). CLASSIFICATION (A.G. Bryukhovetsky, 1991) The classification below takes into account the recommendations of the ICD IX revision. 1. Mechanism of damage: primary (hematogenous), secondary (urinogenic). 2. Localization: a) one-sided; b) bilateral; c) pyelonephritis of a single kidney. 3. Phases of the disease: a) exacerbation; b) unstable remission; c) remission. 4. Current: a) latent; b) recurrent; c) progressive. 5. Main syndromes and complications: a) arterial hypertension; b) chronic renal failure; c) paranephritis; d) hydronephrosis; e) urosepsis; e) dystrophy; g) anemia. Recurrent course is the most common (80%) variant of chronic renal failure, therefore the frequency and degree of exacerbation activity are of particular importance in assessing work capacity and prognosis of progression. 6. Frequency of exacerbations: a) rare exacerbations - once a year or less; b) medium frequency - 2 times a year; c) frequent exacerbations - more than 2 times a year. 7. Degree of activity of exacerbations (G.P. Shultsev, V.I. Burtsev, 1975): 1st degree - mild chills, low-grade fever, mild hematological changes, leukocyturia (according to Nechiporenko up to 10,000 in 1 ml of urine), mild severe bacteriuria (up to 100,000 in 1 ml of urine). 2nd degree - severe weakness, chills, sweating, increased body temperature, leukocytosis, increased ESR, leukocyturia up to 50,000 in 1 ml of urine, true bacteriuria (100,000 in 1 ml of urine or more). 3rd degree - severe general condition, adynamia, pallor, repeated shaking chills, drenching sweat, increased body temperature to 39-40°C. distinct pyuria, severe bacteriuria, renal dysfunction. DIAGNOSTIC CRITERIA 1. The presence of three clinical syndromes: urinary, dysuric and intoxication: a) urinary syndrome includes: leukocyturia (general urine analysis, Nechiporenko test - leukocytes more than 4000 in 1 ml) and bacteriuria (microbial number of at least 100,000 in 1 ml) ; b) dysuric syndrome includes polyuria, nocturia, pain during urination; c) intoxication syndrome is manifested by chills, increased body temperature, and leukocytosis. 2. Results of instrumental studies indicating asymmetric changes in the kidneys, manifested by dilation of the pelvis, dilation or spasm of the necks and changes in the structure of the calyces (ultrasound, isotope renography, kidney scanning, intravenous urography, etc.) EXAMPLES OF FORMULATION OF DIAGNOSIS 1. Secondary bilateral chronic pyelonephritis, phase exacerbation, stage II activity, recurrent course, with rare exacerbations. Secondary symptomatic arterial hypertension. Stage IA chronic renal failure. 2. Nephrolitnaz, left kidney stone. Secondary left-sided chronic pyelonephritis, latent course. CRF - 0. 3. Primary bilateral chronic pyelonephritis, recurrent course with frequent exacerbations, secondary arterial hypertension. Stage IIB chronic renal failure. COURSE AND PROGNOSIS Recurrent course of chronic pyelonephritis is observed in 80% of all cases, while the frequency and degree of activity of exacerbations determine the severity of kidney damage. The latent course of chronic pyelonephritis occurs in 15-20% of cases. The prognosis of chronic pyelonephritis is determined by the timeliness and adequacy of therapy. Otherwise, even with a latent course of the disease, complications gradually arise: arterial hypertension (15-20%), anemia, chronic renal failure. According to summary data from European hemodialysis centers, chronic pyelonephritis is the cause of chronic renal failure in every fifth case. CRF in patients with chronic pyelonephritis occurs 2 times later from the onset of the disease than in glomerulonephritis. Life expectancy after the first signs of chronic renal failure in chronic pyelonephritis is 1.5-2 times higher compared to glomerulonephritis. PRINCIPLES OF TREATMENT 1. The treatment program is based on the identified infectious pathogen, its sensitivity, and the patient’s individual response to the therapy. 2. Early treatment is possible. 3. Complex therapy during an exacerbation: (antibiotics, uroseptics, non-steroidal anti-inflammatory drugs, anticoagulants). 4. Anti-relapse therapy (monotherapy) from 6 months. up to 1-2 years. In this case, medications are prescribed monthly for 7-10 days, and herbal infusions are prescribed in between. In combination with uroantiseptics, therapeutic nutrition, drinking regimen, and physiotherapy are used. 5. Constant clinical observation. ITU are WORKABLE for patients with chronic pyelonephritis with rare exacerbations, in remission, in the absence of significant complications, working in accessible professions and working conditions. VUT CRITERIA Temporary disability is established during an exacerbation of the disease; the occurrence of a hypertensive crisis or a significant increase in blood pressure; the addition of an intercurrent infection; increasing renal failure. Criteria for restoration of working capacity: complete relief of exacerbation of the inflammatory process, normalization or return to the original level of blood pressure, indicators of kidney function. ESTIMATED TERMS OF VUT 1st degree of activity - 4-5 weeks. 2nd degree of activity - 3.5-4 months. 3rd degree of activity - over 4 months. In the case of a significant increase in blood pressure without obvious signs of exacerbation of pyelonephritis, severe neurological and cardiovascular complications, the duration of VUT is 10-12 days. CONTRAINDICATED WORKING CONDITIONS 1. Work associated with significant physical stress. 2.Work at a prescribed pace (on a conveyor belt). 3.Work in unfavorable microclimatic and meteorological conditions. 4.Contact with nephrotoxic poisons. INDICATIONS FOR REFERRAL TO ITU: VUT>4 months. with the 3rd degree of process activity and a favorable labor prognosis (CRF no more than stage IB). VUT<4 months. with the 3rd degree of activity and an unfavorable labor prognosis (CRF IIA and more severe stage). VUT<4 months. in the case of a continuously relapsing course of the disease with high activity (2-3rd degree), severe arterial hypertension. VUT<4 months. with rapid progression of chronic renal failure or the addition of extrarenal complications that are not amenable to conservative therapy. Newly diagnosed chronic pyelonephritis without exacerbation with chronic renal failure stage 0 or I and the impossibility of rational employment according to the conclusion of the Institutional Inspectorate of medical institutions. The required minimum examination when referring patients to MSE (see section “Glomerulonephritis”). Additional research methods: a) urine culture with colony counting; b)ultrasound and radioisotope scanning; c) intravenous urography; d) consultation with a urologist. DISABILITY CRITERIA FOR PYELONEPHRITIS IN ADULTS IN 2020 Disability is not established if the patient has: stage 1 CKD, GFR more than 90 ml/min/1.73 m2; CKD stage 2, GFR within 89 - 60 ml/min/1.73 m2 CKD stage 3A, GFR 59 - 45 ml/min/1.73 m2 Disability of the 3rd group is established if the patient has: CKD stage 3B, GFR 44 - 30 ml/min/1.73 m2. Nephrotic/nephritic syndromes with ineffective treatment with moderately severe impairment of body functions. Disability of the 2nd group is established if the patient has: stage 4 CKD, GFR 29 - 15 ml/min/1.73 m2, preparation for dialysis. CKD stage 5 (GFR below 15 ml/min/1.73 m2) in the absence of dialysis complications. Disability of the 1st group is established if the patient has: stage 5 CKD, GFR below 15 ml/min/1.73 m2, in the presence of complications with significant impairment of body functions. DISABILITY CRITERIA FOR PYELONEPHRITIS IN CHILDREN IN 2020 Disability is not establishedI if the child has: Children 0 - 12 months: GFR is 10 - 20% below the age norm. children over 1 year: - CKD stage 1, GFR more than 90 ml/min/1.73 m2; — CKD stage 2, GFR within 89 - 60 ml/min/1.73 m2. The category “disabled child” is established if the patient has: Children 0 - 12 months: GFR is 30% or more below the age norm; Children over 1 year: CKD from stage 3A and higher with GFR from 59 ml/min/1.73 m2 and lower; Any stage of CKD in diseases with frequent exacerbations or in a latent course of the disease with a high degree of activity of the pathological process; need for drugs that suppress the immune system; ineffectiveness of treatment; in the presence of complications.
A patient can receive an official conclusion on the presence (or absence) of grounds for establishing disability only based on the results of his examination at the ITU Bureau relevant region

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The procedure for completing documents for undergoing MSE (including the algorithm of actions in case of refusal of attending physicians to refer a patient to MSE) is described in sufficient detail in this section of the forum: Registration of disability in simple language
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