Pregnancy can both provoke the appearance of pyelonephritis and aggravate its chronic course. Statistics show that 5-10 percent of women during pregnancy experience a complication in the form of this disease. Pregnancy can reduce the immune defense of a woman’s body, which is the most important factor for the occurrence of this disease.

Reasons for development

Chronic pyelonephritis is considered a disease that affects the pelvis and calyces of the kidneys - the areas of the body responsible for urination. This disease can be acute or chronic. Pregnancy itself is not an illness, but it is quite capable of triggering the development of various pathological processes and exacerbations, including chronic pyelonephritis.

Women during pregnancy need to be extremely attentive to their health if they already have a diagnosis of chronic pyelonephritis. During pregnancy, the expectant mother undergoes serious changes in her body, which provoke inflammatory processes in the kidneys.

Provoking factors:

  1. Under the influence of hormonal changes, a decrease in tone occurs bladder and disorder of movement of the walls of the ureters.
  2. Stagnation of lymph and blood.
  3. The uterus increases in size, squeezing all internal organs, including the ureters.
  4. Fluctuations in blood sugar levels.
  5. Increased glucocorticoid levels.

Chronic pyelonephritis during pregnancy is quite capable of worsening under the influence of such changes in the female body. These factors affect the outflow of urine, leading to its stagnation, which causes inflammation of the kidneys.

In addition, during pregnancy, the placenta synthesizes the hormone estrogen in large quantities, which can contribute to the proliferation of pathogenic flora in this area. The veins of the ovaries also dilate, this leads to stretching of the renal pelvis and stagnation of urine.

Often, worsening pyelonephritis will make itself known in the second half of pregnancy, as the enlarged uterus turns to the right and deviates slightly. This explains the fact that the right kidney is always more susceptible to pathology than the left. The ureter and kidneys, overloaded with urine, become inflamed, for this reason chronic pyelonephritis worsens.

It must be taken into account that the body weight of the expectant mother plays an important role; if the pregnant woman’s weight is very low, then the likelihood of an exacerbation of this disease increases many times over. This situation should be taken into account by the doctor. The doctor usually makes adjustments to the patient’s diet to protect her from such an inflammatory process.

Infectious pathogens usually include:

Often, such processes occur in a woman’s body only from the second trimester to the 8th month of gestation; later the situation improves, as the child descends and the pressure on the kidneys weakens. A woman’s body will be able to fully return to normal only 4-5 months after childbirth.

Manifestations of the disease and possible consequences

The pathological process almost never manifests itself in the first stages of its development. There are no symptoms of this disease, and the woman feels completely normal, although there may be mild pain in the lumbar region, as well as a slightly elevated body temperature.

Signs

Often women do not attach much importance to the negative manifestations of any chronic diseases, because they think that this condition is caused by pregnancy itself, and such symptoms are not dangerous.

Signs of the disease during pregnancy:


At the first manifestation of such symptoms, a woman should immediately consult a doctor. Pregnant women with chronic pyelonephritis are always treated in a hospital setting, home therapy unacceptable.

Risks for the mother

In medicine, there are several degrees of risk that classify this disease in relation to maternal mortality.

  1. Grade 1 means that the disease occurred for the first time during gestation, and pregnancy, in this case, is not contraindicated.
  2. Grade 2 is diagnosed for chronic pyelonephritis that occurs before pregnancy. This means that such women are at a given level of risk for mortality.

Only a doctor can assess the situation, separately in each specific case. Women with this disease will definitely be monitored by a nephrologist and therapist during pregnancy.

Sometimes this pathology is accompanied by additional ailments: anemia, hypertension or the absence of one kidney. In this case, doctors will advise the woman to refuse pregnancy altogether. Many representatives of the fairer sex do not listen to doctors and decide to give birth, despite contraindications, then they will have to sign large number papers reporting high risk. In addition, a pregnancy burdened by such diseases can lead to death for the expectant mother and child.

Expectant mothers should soberly assess the risk to their health, as well as to the health of the child, if they are sick with chronic pyelonephritis. Problems can arise at any stage, and even after the baby is born. If a woman nevertheless decides to give birth, then she needs to take her health as seriously as possible; at the first signs of an exacerbation of the disease, go to the doctor and begin treatment.

When the pathological process is advanced, severe consequences are very likely, and even treatment may become useless.

Therefore, you need to constantly see a doctor and take the necessary tests.

Risks for the child

What is the threat to the fetus from pyelonephritis detected in the mother? It could be:


This pathology is no less dangerous for the expectant mother. The inflammatory process can spread to all nearby tissues, and this leads to glomerulonephritis and renal failure.

A particularly severe course of this disease sometimes leads to kidney abscess and phlegmon, which is deadly.

Treatment and prevention of exacerbation

Therapy for exacerbation of chronic pyelonephritis is based on ensuring the safety of the pregnant woman and her fetus. The doctor carefully analyzes the situation, weighs possible negative influences medications and risk level.

Most often, exacerbation of chronic pyelonephritis during pregnancy is treated with the following drugs:


Before selecting antibacterial drugs, it is necessary to take a urine test from a woman in order to identify the causative agent of infection. Only after this does it become clear which antibiotic will be effective in treating such a pathology.

In addition, such patients need to be administered intravenously Reopoliglucin as a detoxification therapy. Hemodesis is also quite effective.

Such women should have natural childbirth, C-section undesirable in the presence of infectious processes in the body of a pregnant woman. In extreme cases, if there are certain indications, a cesarean section is still performed.

Expectant mothers who suffer from chronic pyelonephritis must:


All food should be healthy. You also need to exclude highly concentrated broths made from mushrooms, fish, and meat from your diet. You can add such broths in small portions to soups with cereals and vegetables.

The main condition that such patients must observe is minimal salt intake, since this substance retains fluid in the body.

This disease is very dangerous, especially during pregnancy. With timely medical assistance, as well as compliance with all preventive measures, this chronic pyelonephritis in pregnant women will not harm either the expectant mother or the fetus. It is very important to start treating an exacerbation as early as possible, then the prognosis will be favorable. The first signs of this pathology should alert a woman and prompt her to take immediate action. The doctor will select the right therapy, and the problem will be solved.

It is one of the most common diseases of pregnant women and poses a danger to the health of mother and child. It occurs in every tenth pregnant woman, and in some cases leads to severe complications, both during pregnancy and after it.

To this we can add that pregnancy itself is a provoking factor leading to the development of acute forms of pyelonephritis. Of course, this causes a more severe course of already formed chronic kidney disease.

Why does chronic pyelonephritis worsen during pregnancy?

During pregnancy, some body functions change, which can cause illness.

The main reason is a violation (more precisely, a complication) of urine passage, due to changes in the location and size of the uterus, as well as the effect of progesterone on the internal receptors of the urinary tract.

The uterus (in the second half of pregnancy) deviates slightly and turns to the right, putting pressure on the right kidney. This, by the way, explains the fact that during exacerbation of pyelonephritis in pregnant women, as a rule, it is the right kidney that suffers more. In the organ itself, expansion of the urinary elements (pyelocalyceal system) is observed, and the ureters expand. The capacity of the urinary tract increases to 50-70 ml (per kidney).


Congestion in the kidney can be caused by oversaturation of urine

The kidney and ureter, overloaded with urine (congestion and high blood pressure), find themselves in a situation favorable for exacerbation of chronic pyelonephritis. In this case, primary pyelonephritis can also form.

These processes are observed in pregnant women with kidney diseases from the 3rd to the 8th month (before the descent of the fetus).

From the 8th month there is an improvement in the condition of the pregnant woman. The kidneys finally return to normal, as a rule, by the 4th month after birth.

Factors provoking exacerbation

The condition of the ligamentous apparatus of the kidneys, as well as the condition of the fat capsule, plays a significant role.

If pregnancy is combined with low body weight, the likelihood of exacerbation of pyelonephritis increases significantly. Try to adjust your diet accordingly during the first trimester.

Of course, the current condition of the kidneys plays a role, as well as the severity of vesicoureteral reflux (i.e., reverse reflux of urine).

Often, exacerbation of pyelonephritis is associated with peak hormone levels, which is quite typical for pregnant women.

In this case, the problem is not so much in the dysfunction of the kidney valve apparatus, but in the influence of estrogen and progesterone on certain types of receptors. This situation A gynecologist-endocrinologist can suspect it in time and help correct it.

Even in the absence of a focus of chronic infection in the body (or with its relative passivity), in pregnant women the infection quite often rises from the bladder or spreads through the lymphatic or circulatory tract.

In the first case, this is facilitated by congestion in the ureters and the kidneys themselves, in the second - a drop in immunity, which is not uncommon during pregnancy.

As a result, an exacerbation of chronic pyelonephritis, or acute kidney infection (acute

The causative agent is most often Escherichia coli, Proteus, Enterococcus, Staphylococcus, Candida.

How dangerous is the disease during pregnancy?

Early toxicosis may be a consequence of exacerbation of chronic pyelonephritis

Exacerbation of pyelonephritis leads to early gestosis (toxicosis), with developed symptoms: pressure rises, edema develops, and there may be convulsions. There is loss of protein in the urine.

Preeclampsia, as we know, is still the main cause of maternal mortality.

Against the background of exacerbation, miscarriages and premature births quite often occur. The placenta may detach prematurely, which also leads to miscarriage.

With severe maternal immunodeficiency, the fetus can be infected with a pathogen that initiates an exacerbation of pyelonephritis. In this case, the child may develop abnormally because his tissues experience hypoxia (lack of oxygen and nutrients).

After exacerbation during pregnancy, pyelonephritis in the period after childbirth is much worse, which affects the quality of life of the mother.

Severe complications of the disease: sepsis (septicemia, septicopyemia), toxic (bacterial) shock. Given the high mortality of these conditions, pregnant women with pyelonephritis are always considered a high-risk group.

If you have (or have had at least once) pyelonephritis or any other kidney disease, be sure to tell your gynecologist about it.

Symptoms of chronic pyelonephritis in expectant mothers

The chronic form can last for quite a long time in the absence of a comprehensive clinic. More precisely, some pain in the lower back is present, as is a slight increase in body temperature, but the patient often does not attach due importance to this.

This occurs either due to the abundance of “special effects” characteristic of pregnancy as a condition (vomiting, bloating, taste disturbances, irritability, etc.), or due to the habit of constant pain from the kidneys (if undertreated or severe pyelonephritis, urolithiasis, etc.).

Signs in the photo

General weakness Nausea and vomiting Change in urine color and odor Fever body

Weakness gradually increases, and the color of urine may change. All this, by the way, can also be attributed by the patient to the pregnancy itself, especially if it is the first pregnancy. Pain appears in the lower back, which can be either dull or sharp (stabbing). The pain usually intensifies when the body bends forward.


At the first signs of exacerbation of chronic pyelonephritis in a pregnant woman, it is necessary to call a doctor

Exacerbation of the chronic process is accompanied by the following phenomena:

  • Body temperature rises to 39-40 0C, chills appear;
  • The pregnant woman begins to feel sick, even vomiting, and her appetite decreases;
  • Urine may appear sharp and bad smell. The color may become reddish;
  • Severe general weakness.
  • high body temperature (38–40 degrees);

Doctors differentiate exacerbation with acute appendicitis, colic, cholecystitis, as well as nephropathies and manifestations. It will not be possible to figure it out on your own, so if the symptoms described above are present, the pregnant woman is hospitalized.

During an exacerbation of chronic pyelonephritis (even if suspected), a pregnant woman absolutely must be hospitalized.

Risk levels

There are 3 levels of risk to prevent maternal mortality. The first includes uncomplicated primary pyelonephritis during pregnancy. IN in this case- There are no special contraindications to pregnancy.

If a woman had chronic pyelonephritis before pregnancy, she already falls into the second risk group.

The first and second groups are additionally observed by a nephrologist or therapist, and most of these pregnancies resolve safely.

If pyelonephritis is combined in a pregnant woman with hypertension, anemia, or there is only one kidney, pregnancy is contraindicated.

Of course, you can keep the fruit, but you will have to sign a lot necessary documents and listen to several subject matter experts. The risk to your life in this case is quite real, and the health of the fetus is at risk right up to (and during) the birth.

Treatment of chronic pyelonephritis in pregnant women


One aspect of treatment is detoxification therapy

Pyelonephritis is treated according to strict principles of therapy, i.e. sow the pathogen, select an antibiotic for it, taking into account contraindications and side effects drug. You need to understand that the benefit/risk ratio can go quite far beyond the boundaries of the drug instructions.

The need to prescribe this or that drug is due to concern for the safety of the mother and fetus. Since life is the highest value, the prescription of non-indicated drugs during exacerbation of chronic pyelonephritis in pregnant women is allowed.

In addition to antibiotics, vitamins, mineral waters(Essentuki No. 20), antispasmodics and diuretics, physiotherapy and exercises.

The pregnant woman undergoes detoxification therapy - rheopolyglucin, protein solutions, hemodez are dripped. To prevent fetal developmental disorders, trental is prescribed (reduces tissue hypoxia).

If treatment is not effective enough, catheterization of the ureters can be performed to ensure stable passage of urine.

An exception may be very strict obstetric indications, for example, a discrepancy between the linear parameters of the small pelvis and the child’s head.

If pyelonephritis is accompanied by severe toxicosis, early delivery is performed.

The woman in labor is observed in the hospital for 10 days, after which she is discharged from the maternity hospital home, under the supervision of a nephrologist (urologist).

If you follow simple nutritional rules, the risk of exacerbations can be reduced

It is necessary to drink a lot of fluid (more than 2 liters per day), avoid fried, spicy and fatty foods. In the absence of associated pathologies digestive system– It is advisable to eat a lot of vegetables and fruits every day.

Meat, fish and mushroom broths are contraindicated (meat, fish and mushrooms can be added to vegetable and cereal broths), since extractive substances can provoke an exacerbation of pyelonephritis.

To reduce the load on the kidneys, it is necessary to reduce the consumption of table salt (total consumption per day is up to 8 g).

When the first signs of exacerbation appear, strict bed rest is indicated. During the period of remission, on the contrary, it is advisable to be quite active, as this improves the flow of urine.

Compliance with these rules, plus timely consultations with specialized specialists, significantly reduces the risk of exacerbation of chronic pyelonephritis during pregnancy. At the first signs of an acute process (fever, weakness, lower back pain), call a doctor immediately.

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Approximately 6 to 12% of pregnant women experience an inflammatory process in the kidneys, which is called pyelonephritis. It is believed that pregnancy provokes this disease. Pyelonephritis during pregnancy poses a danger not only for the expectant mother, but also for the baby. To prevent complications, it is important to diagnose the disease in time and begin the necessary treatment.

Signs of pyelonephritis

Pyelonephritis during pregnancy, which should be treated immediately, is an inflammation of the renal pelvis. It can be provoked by various microorganisms that begin to actively multiply when obstructed urine flow. The source of infection can be a purulent-inflammatory process developing in a woman’s body.

There are primary and secondary pyelonephritis.

  1. They speak of primary when an exacerbation of pyelonephritis during pregnancy occurs for the first time and the woman has never encountered this problem before;
  2. Secondary is an illness that bothered the patient before conception, but during pregnancy it worsened.

The main symptoms of the disease include:

  • increased body temperature;
  • chills;
  • painful urination;
  • pain in the lumbar region (for what reasons pain in this area may bother you, read the article Pain in the right side during pregnancy >>>);
  • headache (article on the topic: Headache during pregnancy >>>);
  • in rare cases, nausea and vomiting appear (sometimes vomiting and nausea accompany a woman at the beginning of pregnancy; what to do in this case, find out from the article Nausea during pregnancy >>>).

Causes of pyelonephritis during pregnancy

  1. Why is pregnancy one of the main factors provoking the onset of the disease? The fact is that as the uterus grows, it begins to put pressure on surrounding organs, including the kidneys. Thus, it can happen in them disturbance of urine outflow;
  2. Pyelonephritis in early pregnancy can occur due to a sharp natural decrease in immunity during this period;
  3. In addition, changes in hormonal balance in pregnant women can lead to various disruptions in the functioning of the female body.

Gestational pyelonephritis - what is it?

Often pregnant women are diagnosed with gestational pyelonephritis. It can affect the expectant mother in any trimester. In its acute course, the disease manifests itself as intoxication of the woman’s entire body. Predisposing factors that can lead to its development include:

  • hypothermia;
  • hereditary diseases of the kidneys and urinary system;
  • cystitis or pyelonephritis, which were observed before pregnancy (read the article on the topic: Cystitis in early pregnancy >>>);
  • diabetes mellitus;
  • bacteriuria during pregnancy.

Gestational pyelonephritis during pregnancy is manifested by the following symptoms:

  1. body temperature over 38 degrees;
  2. pain in the lower back that increases after prolonged standing or walking;
  3. increased blood pressure;
  4. frequent urination;
  5. change in the amount and color of urine.

A clinical urine test helps to diagnose the disease, in which the content of protein, leukocytes and bacteria will be exceeded. Based on this, as a rule, a diagnosis of pyelonephritis during pregnancy is made. The doctor will tell you what to do to cure the disease.

After bacterial culture of urine, it is possible to determine the type of pathogen and to which drug it is sensitive. Later, these medications will be used for treatment. In addition, the doctor will prescribe an ultrasound and Doppler ultrasound to determine the condition of the fetus.

Having learned about the need to use antibiotics, are you worried whether this will harm the baby?

Know! Studies have shown that after the 20th week of pregnancy, when the disease most often occurs, the placenta is already sufficiently formed and can protect the fetus from the action of antibacterial drugs.

In addition, the harm to the baby from their use will be significantly lower than what can be caused to him by gestational pyelonephritis.

With proper and timely treatment, the risk is sharply reduced premature birth- from 50% to 5% - also, the risks of possible disorders in the child decrease. Therefore, the disease requires mandatory treatment, otherwise pyelonephritis during pregnancy can cause the following consequences for the child and mother:

  • hypothermia;
  • malnutrition;
  • intrauterine infection and damage to the fetal nervous system;
  • premature birth;
  • birth of a low birth weight baby;
  • placental abruption.

Treatment of pyelonephritis during pregnancy

Only a doctor can tell you how to treat pyelonephritis during pregnancy. Self-medication in this case can only worsen the woman’s condition and harm the child. To those allowed in this period Antibacterial drugs include:

  1. Ampicillin;
  2. Cephalosporins;
  3. Oxacillin;
  4. Gentamicin.

Important! Treatment should be carried out in a hospital setting under medical supervision.

  • Regardless of the degree of the disease, the patient is prescribed antispasmodics and painkillers. In some cases, acupuncture helps to give up them;
  • To reduce pressure on the ureters and ensure the flow of urine, a woman is recommended to sleep on her side, avoiding the position on her back;
  • Throughout the day, doctors advise standing in a knee-elbow position and staying there for up to 10 minutes. If such methods do not lead to an improvement in the condition of the expectant mother, then she may be prescribed ureteral catheterization or drainage of urine from the damaged kidney;
  • If the disease is accompanied by suppuration, then it is necessary to remove the fibrous capsule or even the diseased organ;
  • If the disease turns out to be very advanced, the doctor may decide on the need for artificial termination of pregnancy;
  • General restorative therapy includes taking sedatives and vitamin-mineral complexes;
  • Compliance with a special diet and drinking regimen is very important. The diet consists of completely excluding fatty, fried, salty, spicy, smoked, and various seasonings from the diet (and about what diet will be useful for any mother during pregnancy, read the article Secrets of proper nutrition for the expectant mother >>>);
  • If the pregnant woman does not have edema, but blood pressure is within normal limits, it is recommended that she drink 2-3 liters of fluid daily. Non-carbonated water, cranberry or berry juice, dried fruit compote, and jelly are suitable for this. But coffee and strong tea must be completely abandoned for the period of treatment;
  • Also, various diuretic teas are not recommended for pregnant women, especially if they contain licorice and bearberry (read more about taking herbs in the article Herbal tea during pregnancy >>>). But the oat decoction may turn out to be a real find. It relieves inflammation and, at the same time, does not affect the tone of the uterus.

To prepare it, you need to pour 1 glass of cereal into 1 liter cold water and boil for 2 hours. After the broth has cooled completely, it should be strained and drunk 0.5 cups before meals.

Prevention of pyelonephritis during pregnancy

To prevent pyelonephritis from bothering the expectant mother, she must follow preventive rules, which include:

  1. Moderate physical activity. Every day you need to walk in the fresh air for at least 1 hour;
  2. Special gymnastics classes. Today you can find courses for pregnant women in almost every fitness center. Thanks to physical exercise, you can strengthen the back muscles, improve tone internal organs and, thereby, prevent inflammatory processes in the kidneys;
  3. If before pregnancy a woman already had kidney diseases, then, from an early stage, she needs to follow a diet that promotes the outflow of urine;
  4. The need to comply with the drinking regime;
  5. Empty your bladder at least every 3-4 hours.

Only by paying close attention to her health and observing the prevention of pyelonephritis can a pregnant woman prevent the development of the disease. But, if symptoms do appear, it is necessary to visit a doctor as soon as possible and take the necessary measures to eliminate the pathology.

While carrying a child, the load on the female body increases significantly, because a lot of resources are needed for the formation and development of the fetus. The presence of any chronic diseases in a woman, one way or another, can affect the course of pregnancy or the health of the unborn baby, as well as diseases acquired during pregnancy itself.

Pregnant women may develop kidney inflammation, called gestational pyelonephritis. The disease is considered dangerous, as it can affect not only the condition of the mother, but also cause serious complications during pregnancy. You cannot let the situation take its course and ignore the problem; it is necessary to consult a doctor in a timely manner - with constant monitoring and appropriate treatment, it is quite possible to minimize the risk to the baby and improve the mother’s condition. Otherwise, dangerous consequences may occur that you need to be aware of.

The influence of pyelonephritis on the course of pregnancy

Pyelonephritis in pregnant women is not uncommon

The disease is so common because its causative agents are so-called opportunistic microorganisms, which provoke the development of an inflammatory process in the kidneys only under the influence of specific factors. The disease can be provoked by E. coli (found in 40% of cases), Proteus, Enterococcus, Streptococcus and other bacteria. Pyelonephritis can be a consequence of fetal growth (an enlarged uterus compresses the ureters), changes in hormonal levels, decreased immunity and previous diseases - almost all of these factors occur in the course of any pregnancy, which explains the high risk of the disease.

Such a diagnosis immediately puts a woman at risk and becomes a reason for constant monitoring by doctors. The disease often appears (or worsens if present before pregnancy) in the period from 22 to 29 weeks, when a sharp change is observed hormonal levels in the body by increasing the levels of sex hormones and corticosteroid-type hormones. If a woman suffered from chronic pyelonephritis even before pregnancy, then this period is considered critical and extremely dangerous. It is worth knowing that in 10% of cases during pregnancy, the chronic form of the disease does not become active and does not manifest itself symptomatically.

A separate difficulty lies in the limited methods that can be used to diagnose the disease. Palpation of organs will not give desired results, since the uterus is greatly enlarged, and therefore it becomes impossible to obtain data on the condition of the organs from the outside, methods using radiation are also contraindicated. The diagnosis of the mother is made on the basis of laboratory analysis of urine and ultrasound examination.

It is important to monitor the state of the body and note any unusual sensations.

The worst consequence of pyelonephritis is termination of pregnancy, which can occur at any stage. Pyelonephritis can cause premature birth and untimely birth amniotic fluid. Complications of pregnancy and childbirth caused by pyelonephritis also include:

  • heavy bleeding during labor;
  • insufficient strength of contractions (in other words, weakness of labor);
  • placental abruption;
  • anemia in the mother during pregnancy.

Half of women diagnosed with pyelonephritis develop a complex condition during pregnancy late toxicosis(or gestosis), which in a third of cases leads to the end of pregnancy with premature birth.

The cause of edema can be both gestosis and more serious conditions.

Late toxicosis caused by pyelonephritis leads to impaired blood circulation throughout the body, it becomes thick and poorly saturated with oxygen, which affects not only the condition of the mother, but also the nutrition of the fetus. Preeclampsia provokes the active appearance of swelling (swelling becomes stronger and appears in atypical places), increased blood pressure, and in some cases negatively affects the central nervous system, provoking convulsions.

Particular difficulties arise in patients with one kidney - the inflammatory process is a direct contraindication to pregnancy. Such a woman can become pregnant only if the kidney is functioning normally, but at the slightest drop in function, doctors terminate the pregnancy.

How does pyelonephritis in the mother affect the unborn child?

The first danger for the baby is the likelihood of transmitting the disease. The consequences of intrauterine infection are very dangerous - the child may develop organ pathologies (the heart and kidneys most often suffer). In fact, any disease that a baby suffers affects his future health. Thus, pyelonephritis can cause weak immunity, which in the future will create favorable conditions for many diseases.

Possible consequences of pyelonephritis for a child (photo)

Jaundice low temperature Weak immunity Irritability

Pyelonephritis - inflammation of the kidney structures (pelvis, calyces, parts of the tubular apparatus) - can be acute or chronic. Acute form most often occurs in girls as a complication of childhood infections, sore throat. Due to unclear or hidden symptoms, it can be missed and unnoticeably become chronic.

Chronic pyelonephritis during pregnancy presents great difficulties. If before the disease was dangerous only for the woman, now it harms the health of the unborn child.

Statistics indicate that kidney inflammation is detected in every tenth pregnant woman (according to other authors - in 5%). Applying the most optimal treatment without affecting the fetus is a serious task that requires a joint decision by obstetricians-gynecologists, therapists, and urologists.

What types of chronic pyelonephritis are possible during pregnancy?

It is important to distinguish two types of chronic pyelonephritis:

  • primary chronic - the acute disease proceeded latently, very quickly, signs of chronic inflammation are revealed almost immediately;
  • secondary - the woman had a previous kidney pathology (urolithiasis, congenital anomalies, cystitis and urethritis) long before pregnancy, great importance is attached to the presence of chronic adnexitis, enterocolitis.

In the primary process, symptoms appear immediately after infection of the kidney tissue, and secondary inflammation lasts for years and can go unnoticed. The infection comes and is replenished from neighboring organs.

If chronic pyelonephritis is provoked and detected during the early stage of pregnancy, then it is called gestational. It is believed that it is associated with overload of diseased kidneys. It is characterized by rapid progression of the disease with the development of chronic renal failure.

To select treatment, it is also important to establish the presence of urinary tract obstruction (obstructions to the flow of urine).

  • With a non-obstructive process the disease is much easier, since the flow of urine washes away and removes some of the bacteria. This serves as one of the defense mechanisms.
  • Obstructive chronic pyelonephritis causes stagnation of urine, increased proliferation of microorganisms, and reflux into higher areas using the mechanism of reflux or reverse flow. This form cannot be cured without normalizing the outflow.

Inflammation can occur in only one kidney or affect both at once (unilateral and bilateral pyelonephritis).

Reasons for the development of pyelonephritis during pregnancy

It has been established that chronic pyelonephritis is more often detected in previously nulliparous women during their first pregnancy. This is associated with a fairly high tone of the muscles of the anterior abdominal wall. They transfer the pressure of the growing uterus from the abdominal press to the ureters and bladder. The compression occurs more severely than in subsequent pregnancies. This contributes to the development of urinary stagnation and increases the risk of infection.

Other reasons:

  • hormonal changes - an increase in progesterone levels by 3 months relaxes the muscles of the bladder and ureters, which leads to curvature, bends, and then to stagnation of urine in the renal pelvis and poor circulation in the tissues;
  • the placenta actively produces estrogens, they contribute to the proliferation of pathogenic flora;
  • dilated ovarian veins also contribute to compression of nearby ureters; anatomically, the most “convenient” conditions for infection are created in the right kidney, therefore chronic pyelonephritis is most often recorded on the right;
  • enlarged uterus in case multiple pregnancy, a narrowed pelvis or a large fetus causes the most pronounced compression of the ureters, women with these features are more likely to become infected;
  • decreased physical activity - a woman, preparing to become a mother, often suffers from toxicosis in the early stages of pregnancy, then it becomes difficult to carry an enlarged belly, her own weight increases, varicose veins veins in the legs, so the usual way of life is replaced by weakness, increased fatigue, and an urge to lie down more.


The “peak” level of progesterone in a pregnant woman is recorded at 17–18 weeks, and estrogen at 13–14 weeks

All together creates and maintains a vicious circle, promoting the penetration of infection and chronic inflammation in the kidneys.

What pathogens should you be wary of?

Infection occurs by microorganisms coming from the external environment (exogenous) and by own bacteria from chronic foci of tonsillitis, sinusitis, cholecystitis, colitis, caries.

Routes of infection:

  • hematogenous - microorganisms are introduced into the bloodstream, activation of old untreated distant lesions is possible (for example, with sinusitis, chronic otitis);
  • lymphogenous - an infection that persists in the lymph nodes travels through the lymphatic vessels to the kidneys; it is located in tissues adjacent to the urinary tract (intestines, genitals).

During pregnancy, infection through the lower urinary tract (urethra, bladder) occurs less frequently.

The sources of the disease are often opportunistic microorganisms that inhabit the intestines and bladder. They become overly active, exhibit aggressive properties, and multiply quickly.

The following is found in the urine of pregnant women:

  • E. coli;
  • staphylococci;
  • enterococci;
  • Pseudomonas aeruginosa;
  • Proteus;
  • Klebsiella

Much less often the causative agents of pyelonephritis are:

  • yeast-like fungi;
  • chlamydia;
  • mycoplasma;
  • ureoplasma.

The important thing is that usually not one pathogenic microorganism is detected, but several at once.

Symptoms of pyelonephritis in pregnant women

Signs of non-obstructive chronic pyelonephritis are difficult to identify. They are often masked by general complaints of pregnant women about:

  • increased fatigue;
  • weakness;
  • feeling of heaviness in the lower back;
  • swelling of the face in the morning.

There is no intense pain or high fever. It is possible to identify signs of renal pathology with ultrasound.

The presence of obstruction significantly complicates the clinical picture of chronic inflammation. The woman notes:

  • pain of a rather intense nature on one side or both in the back and lower back, possibly radiating to the groin;
  • temperature rise to 38 degrees and above;
  • frequent urination with cutting, burning.

This condition is provoked by any options for reducing immune defense:

  • previous influenza or ARVI;
  • stress and anxiety;
  • improper nutrition.


The pain forces the woman to maintain a forced position (pressing her knees to her stomach)

The manifestation of pain depends on the timing of pregnancy:

  • in the first trimester - the pain is very intense, reminiscent of a prolonged attack of renal colic;
  • after 20 weeks they become moderate and gradually disappear.

If chronic pyelonephritis has a long history, then a pregnant woman may have high blood pressure. In this case, the diastolic pressure is significantly higher than normal level. Hypertension of renal origin is characterized by severe course and poor response to medications. A woman has a clinical picture of hypertensive crises:

  • headaches;
  • nausea and vomiting;
  • dizziness;
  • heartbeat;
  • pain in the heart area.

How dangerous is pyelonephritis for a pregnant woman?

In the first trimester, with exacerbation of chronic pyelonephritis, quite severe intoxication occurs. Together with intense pain, it can lead to miscarriage, as the tone of the uterus sharply increases.

The situation is complicated by limitations in use medicines. It is difficult to find effective and safe antibacterial agents. The effect of most antibiotics on the pregnant uterus causes irreversible pathology of the fetus and increased tone.

The following adverse effects are considered complications from chronic pyelonephritis:

  • gestosis;
  • spontaneous miscarriage early stages(up to 22 weeks) or premature birth;
  • placental insufficiency, hypoxia, abruption and fetal death - urinary retention and acute expansion of the pelvicaliceal volume causes spasm of the capillary network, narrowing of the arteries, and accordingly the nutrition of the placenta worsens;
  • the development of anemia is typical for the second trimester;
  • polyhydramnios;
  • renal hypertension;
  • accelerated formation of renal failure against the background of a shriveled kidney;
  • infectious-toxic shock with massive bacterial proliferation.

What disorders may occur in the fetus?

For a child, chronic pyelonephritis of the mother is no less dangerous.


The disease disrupts the developmental conditions of the fetus, starting from the embryonic stage

The most severe consequences are:

  • the formation of congenital defects and developmental anomalies that cause oxygen deficiency (hypoxia) and maternal anemia;
  • the risk of intrauterine infection increases when bacteria enter the blood;
  • death at different stages and periods of pregnancy.

Less severe, but very significant, include the child’s sharply reduced immunity. This prevents him from adapting to independent life, constantly threatens with counter infections, impedes growth and development.

Methods for diagnosing pyelonephritis during pregnancy

After clarifying the complaints, the doctor conducts a mandatory examination of the pregnant woman. In the early stages, in thin women, the edge of the kidneys can be palpated. Pain on palpation and a positive Pasternatsky sign (tapping on the lower back) suggest pyelonephritis.

During pregnancy, all women must undergo regular blood and urine tests. Signs of chronic pyelonephritis include:

  • acceleration of ESR in the blood and leukocytosis;
  • in the urine - a significant number of leukocytes, the formation of active cells, protein, and an increased content of bacteria.

If bacteriuria is detected, they are referred for a bacteriological analysis of urine to determine sensitivity to antimicrobial drugs. This helps select treatment.


Using ultrasound, abnormal sizes of the kidneys and their structures, stone formation in the urinary tract are determined

X-ray examination with contrast or against the background of an air bubble is not used in pregnant women due to increased radiation exposure to the uterine area. But after giving birth, a woman needs to complete the examination in order to have a complete understanding of the causes of chronic kidney damage.

How can chronic pyelonephritis be treated during pregnancy?

The complexity of treatment during pregnancy is due to the increased toxicity of drugs for the unborn child. Therefore, the requirements for non-drug methods of influencing inflammation are increasing to the maximum.

During the period of exacerbation, the woman is hospitalized in the pregnancy pathology department at the perinatal center. She is assigned:

  • bed rest for maximum kidney sparing during symptoms of intoxication;
  • It is recommended to sleep on your healthy side;
  • therapeutic exercises during the period of subsidence of the main process and with satisfactory health;
  • diet with the obligatory addition of fresh vegetables and fruits, dairy products;
  • for drinking berry fruit drinks, dried fruit compotes, fresh juices from cranberries, lingonberries, currants, sea buckthorn, gooseberries, mineral waters.


For pyelonephritis, exercises in the knee-elbow position are indicated

In the case of a mild flow, the above measures are sufficient. But with severe pain, high temperature and other signs of intoxication, drugs with antibacterial action are prescribed. Broad-spectrum antibiotics, which can destroy different types microorganisms. The course of treatment depends on the effectiveness. For pregnant women, they try to limit the use of antibiotic injections to seven days.

Antispasmodics are used to relieve pain.

Vitamins are prescribed at the same time. Probiotic preparations that restore normal intestinal flora (Bifidumbacterin, Acipol) are considered useful.

To enhance the flushing effect, herbal diuretics (Canephron, Brusniver) are prescribed. Recommend some herbal infusions from the tips traditional healers. Plants should not increase the tone of the uterus. They are best used during the remission stage, to prevent exacerbation.

The following can be included in kidney tea after your doctor’s permission:

  • marsh calamus;
  • bearberry;
  • flax seeds;
  • birch buds;
  • licorice root.


Calamus roots are collected in autumn or early spring

In case of severe intoxication, the liquid is additionally administered intravenously.

If the course of chronic pyelonephritis is complicated by suppurative processes in the kidneys, hypertension with heart failure, then you have to think about saving the mother’s life. At any stage of pregnancy, surgery to remove the kidney is performed under general anesthesia.

It is better for a woman who has suffered an exacerbation of chronic pyelonephritis to give birth in a specialized maternity ward. May be required emergency assistance, C-section.

How to avoid exacerbation of pyelonephritis?

Prevention of pyelonephritis should be done both before and during pregnancy. Knowing about her disease, a woman should undergo a full check-up before conceiving and, if necessary, receive sufficient antibacterial therapy.

  • support as much as possible motor mode(morning exercises, walking, swimming);
  • the diet must be complete and must contain fruits, vegetables, protein from meat and fish;
  • drinking a regime of two liters per day will help flush the urinary system;
  • dress warmly in chilly weather;
  • do not delay emptying the bladder, go to the toilet regularly every 3-4 hours;
  • do not self-medicate, contact your obstetrician-gynecologist in a timely manner, get tested and truthfully talk about disturbing disorders.

The confidence of some expectant mothers in their health can only be welcomed if it is confirmed by tests. Observation in antenatal clinic and periodic hospitalization helps to avoid difficult situations during childbirth and protect the child.