Urinary tract infections are among the most common infectious diseases in humans and are widely encountered in outpatient and inpatient practice.<\/p>\n
The regional conference of nephrologists, held in Vinnitsa, was dedicated to the rehabilitation of patients with kidney pathology. Of particular interest were approaches to the rehabilitation of patients with kidney infections due to the significant prevalence of this pathology both in Ukraine and throughout the world.<\/p>\n
Urinary tract infections can occur with primary involvement in the pathological process of one or another organ (pyelonephritis, cystitis, prostatitis, urethritis), with the involvement of different organs or without clear signs indicating involvement of the kidneys or other parts of the urinary tract in the process - in this case talk about a \u201curinary tract infection.\u201d This term seems to be the most correct, since with any local inflammation in the urinary system, all structures of the urinary tract are involved to one degree or another in the infectious process.<\/p>\n
Data on the prevalence of urinary tract infections are very disappointing. Thus, according to the US Department of Medicine, urinary tract infections were the reason for visiting a doctor in 7 million patients in 2001, and for 1 million of them they were the reason for hospitalization.<\/p>\n
In 2002, about 550 thousand patients were registered in Ukraine belonging to the group of diseases \u201ckidney infections\u201d, which amounted to 1,364.9 per 100 thousand adult population and about 52 thousand patients with chronic cystitis, which amounted to 126.5 per 100 thousand adult population. Thus, recently there has been a tendency towards an increase in the number of inflammatory processes in the genitourinary area. First of all, this trend is due to a decrease in the immunological resistance of the body as a whole, a change in the virulence and pathogenicity of the microflora that causes this pathology, the development of urinary tract infections against the background of concomitant pathologies: diabetes mellitus, urolithiasis, oncopathology, various types of immunodeficiency.<\/p>\n
All this leads to frequent chronic infection, recurrence and reinfection, long-term disability of patients, and a deterioration in their quality of life.<\/p>\n
Considering the above, it becomes obvious the need for prevention and rehabilitation of patients with chronic urinary tract infection at the outpatient stage.<\/p>\n
Patients with frequently recurring urinary tract infections (more than two exacerbations within 6 months or three exacerbations within a year) should receive preventive therapy. For this purpose, long-term prophylactic use of low doses of fluoroquinolones, co-trimoxazole, and, in adolescents, pregnant and lactating women, oral cephalosporins is used. However, given the possibility of adverse drug reactions during long-term chemotherapy, such as allergic reactions, intestinal dysbiosis, thrombocytopenia, hemolytic anemia (while taking co-trimoxazole) and the development of interstitial nephritis, as well as remembering the inappropriateness of long-term antibiotic therapy when treating adolescents, elderly people, pregnant women, patients with diabetes mellitus, chronic hepatitis, the search for combined herbal medicines suitable for long-term therapy is justified. Their advantages over synthetic drugs are obvious in most cases. Firstly, there are no complications or unwanted side effects. Secondly, there is a wide scope for maneuvering, which is provided by a rich selection of plants that have different types of effects.<\/p>\n
The priority of using medicinal plants is determined by the nature of pathological changes, the phase of the disease, and the presence of complications. An example of such a medicine would be the herbal drug Canephron N. The herbal components included in the drug have a complex effect, which is manifested by anti-inflammatory and antispasmodic, diuretic, vasodilating and antibacterial effects, and the ability to potentiate the effect of antimicrobial drugs. Under the influence of rosmarinic acid, the release of inflammatory mediators is inhibited, which determines the persistence of the anti-inflammatory effect. All plant components included in the preparation contain substances with a wide spectrum of antimicrobial action (phenolcarboxylic acids, essential oils). The effect of the drug on the tubular and glomerular nephron system leads to a decrease in the severity of proteinuria.<\/p>\n
It is important to emphasize the wide antimicrobial spectrum of biologically active substances of medicinal plants and their activity against microflora resistant to synthetic drugs. Their advantage is the combination of antimicrobial and anti-inflammatory properties, which is especially valuable for chronic processes in the urinary tract (Pytel Yu. A., Amosov A. V., 1999; Amosov O. V., 2000). The diuretic effect of the drug Canephron N is due to the combination of various points of application of medicinal components. Essential oils promote the dilation of renal vessels - the blood supply to the renal epithelium improves, and also affect the reabsorption function of the epithelium of the renal tubules (Jacobi G. H., 1993). The mechanism of the diuretic action of phenolcarboxylic acids is due to osmotic effects (Pytel Yu. A., Amosov A. V., 1999; Amosov O. V., 2000).<\/p>\n
Due to the removal of excess fluid and sodium salts from the body, Canephron N helps lower blood pressure. The duration of use of the drug depends on the clinical picture of the disease.<\/p>\n
An important link in the rehabilitation of patients with microbial inflammatory diseases of the urinary tract is the use of immunomodulatory therapy. In particular, the domestic drug proteflazide, which has undergone clinical trials at the Kiev Research Institute of Urology and a number of other clinics, including the Vinnytsia City Nephrology Clinic, has proven itself well in this category of patients. Proteflazid is an extract from wild cereals, consisting of a number of biologically active compounds, the main part of which is quercetin and other flavonoids.<\/p>\n
When carrying out rehabilitation measures in patients with urinary tract infections, it is necessary to take into account such a factor as the frequent presence of complications after taking antibacterial drugs. Long-term or short-term, but massive antibacterial therapy leads not only to positive results - sanitation, but also to quite severe consequences in the form of intestinal dysbiosis, and, as a rule, to dysbiosis of the whole organism. Therefore, restoration of normal microflora is a mandatory stage of rehabilitation for all patients receiving antibacterial therapy, and for patients with chronic infections, preliminary or background use of drugs that prevent the development of dysbiosis (probiotics) is also important. The most studied and successful choice for this is lactulose (Duphalac, Normaze), since it combines undoubted effectiveness in maintaining the normal ecology of the body - the dominant role of bifidobacteria and lactobacilli of the large intestine (which is why it got its name \u201cbifidogenic factor\u201d, or \u201c bifidus factor") and complete safety for patients of all ages with any concomitant pathology. Lactulose is a synthetic isomer of lactose obtained from cow's milk.<\/p>\n
From the standpoint of modern ideas about intestinal physiology, the importance of intestinal microbiocenosis in the human body can hardly be overestimated. The gastrointestinal tract is a complex symbiotic ecosystem. The symbiosis of macro- and microorganisms is that the host \u201ctakes care\u201d of the intestinal microflora, providing it with nutrients, and the microflora provides the macroorganism with the metabolites it needs and protects it from the introduction of pathogenic microbes. Therefore, regular preventive use of lactulose protects the body not only from intestinal infections, but also from infections of the respiratory tract and genitourinary system. A marked improvement is observed in patients suffering from chronic urinary tract infections, which is manifested in a decrease in the frequency of exacerbations.<\/p>\n
It has been proven that putrefactive and pathogenic bacteria produce toxic substances in the intestines: ammonia, amines, indole, etc., and the metabolic products of pathogenic and putrefactive bacteria have a toxic effect on the human body, and primarily on the parenchymal organs responsible for detoxification and excretion, - liver and kidneys. Thus, arising as a result of antibacterial therapy, intestinal dysbiosis leads to disruption of a number of body functions, contributes to the development of disturbances in the functioning of organs and systems and the subsequent recurrence and chronicity of infectious processes.<\/strong><\/p>\n By inhibiting pathogenic flora, lactulose thereby prevents the penetration of toxic products into the blood - ammonia and ammonium-containing substances, which is always important for patients with kidney pathology. Lactulose (Lactusan) has a beneficial effect on the body in case of renal failure. (In case of renal failure, the excretion of nitrogen in the urine is reduced and its accumulation in the blood occurs - azotemia. In such cases, purification of the blood from urea is carried out using dialysis, which causes certain difficulties). The problem can be partly solved by limiting the use of proteins in the diet. Studies have shown that for moderate azotemia, reducing the concentration of nitrogen in the blood with lactulose turned out to be very effective. The positive effect of lactulose in this case is to reduce the load on the kidneys with nitrogen and aromatic amines, reducing the concentration of phosphates in the blood serum mainly due to the removal of water and sodium ions.<\/strong><\/p>\n Therefore, using lactulose from the very beginning of treatment of patients with kidney infections, at least 2 problems are solved at once: a normal nutrient environment is created for one\u2019s own microflora and the development of dysbiosis is prevented; lactulose helps detoxify the body from excess amounts of ammonia, which manifests itself during exacerbation of chronic infections as a consequence of decreased kidney function.<\/strong><\/p>","protected":false},"excerpt":{"rendered":" \u0418\u043d\u0444\u0435\u043a\u0446\u0438\u0438 \u043c\u043e\u0447\u0435\u0432\u044b\u0432\u043e\u0434\u044f\u0449\u0438\u0445 \u043f\u0443\u0442\u0435\u0439 \u043e\u0442\u043d\u043e\u0441\u044f\u0442\u0441\u044f \u043a\u00a0\u0447\u0438\u0441\u043b\u0443 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