Why do the kidneys become inflamed during pregnancy?
From early stages, progesterone reduces the tone of the ureters, they expand, and urine moves more slowly. From the second trimester, the growing uterus additionally puts pressure on the ureters, often on the right. In stagnant urine, bacteria multiply more freely and rise from the bladder to the kidney. Therefore, even asymptomatic bacteriuria, which often does not require treatment outside of pregnancy, must be treated in pregnant women: without therapy, in about a third of cases it turns into pyelonephritis. It is because of this that urine culture is included in the examination plan during registration.
- Dilation of the ureters under the influence of progesterone
- Compression of the ureters by the growing uterus
- Slow urine flow and stagnation
- Ascending bladder infection
- The right kidney is most often affected
Symptoms
A typical onset is a sharp rise in temperature with chills, body aches and dull or bursting pain in the lower back, usually on one side. Nausea and vomiting are often associated, which is why the condition is initially mistaken for poisoning. Urination may be frequent and painful, urine may be cloudy and have an unpleasant odor. In some women, the disease progresses silently, and the only sign is changes in urine analysis. Therefore, during pregnancy, a urine test is taken before each visit to the doctor.
- Temperature 38 °C or higher, chills
- Lower back pain, often unilateral
- Nausea and vomiting
- Frequent and painful urination
- Cloudy urine with a strong odor
- Marked weakness and weakness
Diagnostics
The basis of the diagnosis is a general urine test with an increased number of leukocytes and bacteria and urine culture, which shows the specific pathogen and its sensitivity to antibiotics. Cultures are taken before the start of treatment, but they will not wait for its result to begin therapy at a high temperature. A general blood test shows signs of bacterial inflammation. Ultrasound of the kidneys shows expansion of the collecting system, stones and purulent foci. X-ray methods are not used during pregnancy, with rare exceptions for health reasons.
- General urine analysis and urine analysis according to Nechiporenko
- Urine culture with sensitivity determination
- General clinical blood test
- Creatinine and blood urea
- Ultrasound of the kidneys and bladder
- Monitoring the condition of the fetus by ultrasound and heartbeat
Treatment
Treatment is carried out in a hospital: intravenous antibiotics, temperature control, fetal condition and sufficient fluid intake are required. Only those groups of drugs that are allowed during pregnancy are selected, and after obtaining a culture, the regimen is changed if necessary. The course is continued in full, even if the temperature returns to normal on the second day. If the outflow of urine is impaired by a stone or strong compression, the urologist installs a ureteral stent or nephrostomy - without restoring the outflow, antibiotics do not work. Self-selection of medications and warming up the lower back are unacceptable.
- Hospitalization and intravenous antibiotics
- Correction of the scheme based on the results of sowing
- Full course of treatment, not until improvement
- Drink plenty of fluids in the absence of contraindications
- Drainage of the kidney in case of obstruction of urine outflow
- Monitoring the condition of the fetus throughout treatment
Prevention and follow-up after recovery
After suffering from pyelonephritis, urine analysis and culture are repeated regularly until the end of pregnancy, because relapses occur quite often. For some women, the doctor prescribes long-term preventive therapy with low doses of antibiotics. Simple household measures also work: do not tolerate the urge, drink enough water, empty your bladder after intimacy, sleep on the side opposite the sore kidney. The knee-elbow position several times a day helps relieve the ureters. Any medications, including herbal ones, should be discussed with your doctor.
- Control urine tests and cultures before birth
- Prophylactic antibiotic use as prescribed by a doctor
- Sufficient drinking regime
- Timely emptying of the bladder
- Knee-elbow position for 10–15 minutes
- Treatment of asymptomatic bacteriuria is mandatory
