La pielonefrite è la conseguenza di un’infezione delle vie urinarie che dalla vescica all’uretra è risalita fino ai reni e agli ureteri. I reni sono i filtri del nostro sangue e quindi da loro si sviluppa l’urina con gli scarti del nostro organismo, mentre gli uretri sono due tubicini che dai reni conducono le urine alla vescica per la loro espulsione, che avviene poi attraverso l’uretra. Quando si parla di infezioni delle vie urinarie (IVU) si fa riferimento ad una contaminazione batterica in una di queste aree: nei reni si parla di pielonefrite (nella vescica di cistite). La maggior parte dei casi di pielonefrite acuta o cronica (più rara) sono complicazioni di comuni infezioni della vescica. La pielonefrite è una patologia potenzialmente grave, ma per fortuna è quasi sempre curabile. Come?
Cura per la pielonefrite
Nella maggior parte dei casi la pielonefrite si cura con antibiotici per via orale e non è necessario il ricovero ospedaliero. L’ospedalizzazione è necessaria solo in caso di forme gravi, per le quali si effettua la somministrazione di farmaci per via endovenosa. Gli antibiotici vanno somministrati per almeno 7 giorni consecutivi: la terapia prescritta può essere però anche di 10-14 giorni. Il tipo di antibiotico dipende dalla possibile identificazione dei batteri responsabili (che in genere si effettua con urinocoltura). Più comunemente si usano:
- levofloxacina
- ciprofloxacina
- cotrimoxazolo
- ampicillina
Se non è possibile un’urinocolutura si usano antibiotici ad ampio spettro proprio come l’ampicillina. In alcuni casi, la terapia farmacologica è inefficace. Ed è in questo caso che eventualmente si stabilisce un ricovero. Infezioni renali ricorrenti (pielonefrite cronica) possono derivare da un problema medico di base. Per cui, oltre la terapia farmacologica ed antibiotica possono essere utili altre opzioni, come la chirurgia, atta a correggere ad esempio, un difetto fisico.
Complicanze
La pielonefrite acuta se presa per tempo non provoca complicanze, ma il rischio è sempre quello di sviluppare una malattia renale cronica. Anche la pielonefrite cronica è tra queste e può significare un danneggiamento dei reni. Seppur di rado, da qui, l’infezione può diffondersi al sangue e provocare sepsi, con rischio per la vita del paziente. Altre complicazioni includono:
- infezioni renali ricorrenti
- la diffusione dell’infezione alle aree attorno ai reni
- insufficienza renale acuta
- ascesso renale
Gli ascessi sono difficili o impossibili da curare con i soli antibiotici: necessitano di un drenaggio.
Pielonefrite acuta e cronica, la differenza
La maggior parte dei casi di pielonefrite acuta si manifestano improvvisamente: se la cura antibiotica è repentina e mirata non si hanno danni permanenti, se non di rado. Nella maggioranza delle persone, il problema non si ripresenta. La pielonefrite cronica (o ricorrente) è infatti abitualmente provocata da difetti organici/fisici del rene, congeniti. Oppure, infezioni urinarie ricorrenti nei bambini possono dar luogo a cicatrizzazioni e quindi ad un danno progressivo del rene, fino al rischio di insufficienza renale. Questa condizione, la pielonefrite cronica, come è facile comprendere, è più comune nei bambini e si scopre già dall’infanzia.
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