Pregnancy management tactics for obstructive pyelonephritis

Nikolskaya, I. G.; Базаев, В В; Bychkova, N. V.; Urenkov, S B; Иванов, А. Е.; Biryukova, N. V.; Федотова, А. В.

doi:10.17116/rosakush201616373-78

Ross. vestn. akush.-ginekol.

2016

DOI: 10.17116/rosakush201616373-78

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Pregnancy management tactics for obstructive pyelonephritis

I. G. Nikolskaya¹,

В В Базаев²,

N. V. Bychkova³

et al.

Abstract: Частота инфекции мочевыводящих путей (ИМП) значительно повышается у беременных с хронической болезнью почек (ХБП), при которой выявление истинной бактериурии соответствует, по нашим данным, 38,2% [1]. Наиболее часто рост микроорганизмов выявляется у бере-менных с вторичным хроническим пиелонефритом на фоне МКБ и врожденных аномалий мочевой системы, где этот показатель соответствует 70,2% и почти в 2 раза пре-вышает таковой при хроническом гломерулонефрите -45%.Согласно Дренирование верхних мочевых путей у бере… Show more

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Cited by 3 publications

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Recurrent vesicoureteral reflux during pregnancy

Nikolskaya¹,

Базаев²,

Prokopenko³

et al. 2017

Ross. vestn. akush.-ginekol.

Self Cite

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областной научно-исследовательский институт акушерства и гинекологии» (дир.-проф. В.А. Петрухин) Минздрава Московской области, Москва, Россия; 2 урологическая клиника (рук.-проф. В.В. Базаев) Московского областного научно-исследовательского клинического института им. М.Ф. Владимирского (дир.-член-корр. РАН, проф. Ф.Н. Палеев), Минздрава Московской области, Москва, Россия; 3 кафедра трансплантологии, нефрологии и искусственных органов (зав.-проф. А.В. Ватазин) Московского областного научно-исследовательского клинического института им. М.Ф. Владимирского (дир.-членкорр. РАН, проф. Ф.Н. Палеев) Минздрава Московской области, Москва, Россия Беременность, способствуя нарушению уродинамики по мере увеличения ее сроков и массы плода, может создавать у больных, оперированных по поводу пузырно-мочеточникового рефлюкса, новый риск декомпенсации функции уретеровезикального сегмента за счет сдавления беременной маткой. Представлено клиническое наблюдение беременности и родов у пациентки с аномалией мочевой системы, двусторонним рефлюксирующим мегауретером, перенесшей уретероцистонеостемию с антирефлюксной защитой с обеих сторон по Лидбеттеру-Политано в возрасте 6 лет, хроническим пиелонефритом. Проводился тщательный динамический контроль за состоянием беременной: уровнем креатинина, скоростью клубочковой фильтрации, степенью дилатации верхних мочевых путей, температурой тела, артериальным давлением, признаками инфекции мочевыводящих путей. Проводилось исследование современного маркера преэклампсии-ангиогенного коэффициента, использовался мультидисциплинарный подход в ведении данной беременной. В связи с трансформацией рецидивного пузырно-мочеточникового рефлюкса в обструктивный уретерогидронефроз, связанный со сдавлением беременной маткой нижних отделов мочеточников, ростом уровня креатинина более 200 мкмоль/л, на 31-й неделе беременности проведено внутреннее дренирование почек и мочевого пузыря путем двустороннего стентирования мочеточников и установки мочепузырного катетера Фоллея. Отмечено, что данную операцию следовало провести раньше-в начале второй половины беременности. В статье подчеркнуто, что благоприятный исход беременности у больных с рефлюксирующим мегауретером зависит от динамического индивидуального интенсивного мультидисциплинарного наблюдения, клинического, лабораторного и инструментального обследования пациентки, своевременной коррекции нарушений, хорошей комплаентности самих пациенток. Ключевые слова: беременность, аномалия мочевой системы, антирефлюксная операция, рецидив пузырномочеточникового рефлюкса, уретерогидронефроз, дренирование мочеточников и мочевого пузыря, мониторинг признаков преэклампсии.

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Recurrent vesicoureteral reflux during pregnancy

Nikolskaya¹,

Базаев²,

Prokopenko³

et al. 2017

Ross. vestn. akush.-ginekol.

Self Cite

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Urolithiasis-induced obstructive uropathy in pregnant women: Current approaches to treatment

Базаев¹,

Nikolskaya²,

Bychkova³

et al. 2018

Ross. vestn. akush.-ginekol.

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Emergency drainage of the upper urinary tract for obstructive uropathy and/or acute pyelonephritis in pregnant women is a vital operation. Objective-to compare complications due to internal and external drainages of the upper urinary tract in pregnant women with obstructive uropathy in order to choose the most optimal method. Subject and methods. Among 48 treated pregnant women (28 patients with obstructive uropathy and 20 with acute pyelonephritis), 41 patients underwent follow-up, examination, and treatment and were divided into 2 groups. Group 1 included 21 pregnant women with obstructive uropathy at 12-32 weeks' gestation, in whom double-J upper urinary tract stenting was chosen as a drainage procedure; group 2 consisted of 20 pregnant women with clinical signs of acute pyelonephritis at 22-23 weeks' gestation who had percutaneous needle nephrostomy. All emergency surgical interventions were performed within 24 hours of admission and antibiotic therapy. Results. It was established that Group 1 undergoing upper urinary tract stenting showed the largest number of complications (stent dislocation and encrustation, vesicoureteral reflux, and reflux pyelonephritis), which required the highest number of therapeutic measures. In Group 2, the complications were associated with drainage dysfunction (salt-induced obstruction, spontaneous drainage discharge) and were observed much less frequently. Contraindications to ureteral stenting and indications for contact ureterolithotripsy, minimally invasive surgery, were developed. Percutaneous needle nephrostomy is a universal method of upper urinary tract drainage, which can be used at any gestation period and for any reason of obstruction. Conclusion. The high rates of drainage-associated complications necessitate a differentiated approach to choosing a drainage method for obstructive uropathy or acute pyelonephritis in pregnant women and to preventing catheter-associated complications in previously performed stenting.

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Clinical Features of Urinary Infections in Pregnant Women with Type 1 Diabetes Mellitus

Alekseenko

Иванова

2020

Kuban. nauсh. med. vestnik

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Aim. To study clinical manifestations of urinary tract infections in pregnant women with type 1 diabetes mellitus (DM).Materials and methods. Pregnant women with urinary tract infections (UTIs) were examined: 110 with type 1 diabetes mellitus (main group) and 133 without diabetes mellitus (comparison group). The diagnosis of UTI was based on the clinical picture (for manifestation forms) and confirmed by a dual culture method using both the classical approach and DipStreak tests. The determination of the sensitivity of the isolated microorganisms to antibacterial drugs was carried out by the disk diffusion test on Mueller-Hinton agar using paper disks. Instrumental research included ultrasound of the kidneys, urinary tract and fetoplacental complex.Results. In the main group, UTIs were pyelonephritis, asymptomatic bacteriuria (AB) and low AB (102–104 CFU/ml) was detected in 38, 69 and 31 patients, respectively. In the comparison group, pyelonephritis, AB and low AB was detected in 41, 63 and 29 patients, respectively. In the main group, the classic course of pyelonephritis was observed in 44.7%, low-symptomatic — in 26.3%, “according to the type of carbohydrate metabolism decompensation” — in 21%, and the obstetric variant — in 7.9% of patients. In the comparison group, the classic version of pyelonephritis was in 70.7%, low-symptomatic — in 24.4%, asymptomatic — in 4.9%. Bilateral pyelonephritis in pregnant women with type 1 diabetes mellitus prevailed over unilateral: 65.8 vs 34.2%. During AB, in patients with type 1 diabetes mellitus, hyperglycemia was observed in 23.1% (n = 16), the threat of pregnancy termination in 53.6% (n = 37), and moderate preeclampsia in 17.4% (n = 12). In patients with low AB, glycemia above the target values was recorded in 16.1% (n = 5), the threat of pregnancy termination in 38.7% (n = 12), and moderate preeclampsia in 12.9% (n = 4).Conclusion. Based on the specifics of the clinical manifestations of UTIs in pregnant women with type 1 diabetes mellitus, the following types of pyelonephritis can be distinguished: classic, low-symptom, “decompensation of carbohydrate metabolism” and obstetric. The classical course of pyelonephritis in pregnant women with type 1 diabetes mellitus is statistically significantly less common (p <0.05) as compared with pregnant women without diabetes mellitus. The features of AB in pregnant women with type 1 diabetes mellitus are the development of hyperglycemia and obstetric complications.

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Pregnancy management tactics for obstructive pyelonephritis

Cited by 3 publications

References 14 publications

Recurrent vesicoureteral reflux during pregnancy

Recurrent vesicoureteral reflux during pregnancy

Urolithiasis-induced obstructive uropathy in pregnant women: Current approaches to treatment

Clinical Features of Urinary Infections in Pregnant Women with Type 1 Diabetes Mellitus

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