Risk assessment scale for the development of acute pyelonephritis in women at different stages of pregnancy

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. The authors consider gestational pyelonephritis as a relevant clinical problem requiring timely diagnosis and a well-grounded choice of treatment strategy.

Aim. To develop and validate a scale for stratifying the risk of acute pyelonephritis in pregnant women, allowing determination of the optimal management strategy (conservative therapy or upper urinary tract drainage) at various gestational stages.

Materials and methods. A retrospective analysis was performed on 161 cases of urinary tract infection in pregnant women: 73 patients observed in 2024 using the proposed scale and 88 patients from 2023, who formed the control group.

Results. Implementation of the scale in 2024 increased the frequency of ureteral stenting (32.8% vs. 17% in 2023) and reduced the number of cases with kidney decapsulation (2.9% vs. 3.5%). A statistically significant increase was observed in the proportion of hospitalizations during the third trimester (20.6% vs. 6.8% in the first trimester), indicating more accurate risk stratification and timely selection of treatment tactics.

Conclusion. The developed scale facilitates objectification of clinical decisions in managing pregnant women with gestational pyelonephritis, ensures timely drainage in high-risk patients, and reduces the frequency of unnecessary invasive interventions.

Full Text

Restricted Access

About the authors

Yerlan M. Konyrov

Al-Farabi Kazakh National University

Author for correspondence.
Email: doc_konyr@mail.ru
ORCID iD: 0009-0008-4248-8506

Doctoral Student

Kazakhstan, Almaty

Bulat U. Shalekenov

Al-Farabi Kazakh National University

Email: prof.s.bulat@gmail.com
ORCID iD: 0000-0003-4818-7348

Ph.D., MD, Professor, Department of Clinical Disciplines, Higher School of Medicine, Faculty of Medicine and Healthcare

Kazakhstan, Almaty

Sanzhar B. Shalekenov

Al-Farabi Kazakh National University

Email: s.shalekenov@gmail.com
ORCID iD: 0000-0003-3400-9823

Ph.D., Doctor der Medizin (Germany), First Deputy Chairman of the Board, National Scientific Oncological Center; Associate Professor, Department of Urology

Kazakhstan, Almaty

Ayagoz E. Apenova

Maternity Hospital No. 5 of Almaty

Email: ayagoz___@mail.ru
ORCID iD: 0009-0005-7035-735X

Obstetrician and Gynecologist, Master of Public Health

Kazakhstan, Almaty

References

  1. Nogayeva MG, Tuleutayeva SA. Asymptomatic Bacteriuria in Pregnant Women in Outpatient Facilities. Cent Asian J Glob Health. 2015 Feb 19;4(1):53. doi: 10.5195/cajgh.2015.53. PMID: 29138709; PMCID: PMC5661201.
  2. Naboka Yu.L., Rymashevsky A.N., Kogan O.M., Gudima I.A., Vorobyeva N.V., Alkina A.K. Asymptomatic bacteriuria and pyelonephritis in pregnancy. Medical Bulletin of the South of Russia. 2021;12(3):22-31. doi: 10.21886/2219-8075-2021-12-3-22-31. Russian (Набока Ю.Л., Рымашевский А.Н., Коган О.М., Гудима И.А., Воробьева Н.В., Алькина А.К. Бессимптомная бактериурия и пиелонефрит при беременности. Медицинский вестник Юга России. 2021;12(3):22-31. doi: 10.21886/2219-8075-2021-12-3-22-31).
  3. Radzinsky V.E., Ordiyants I.M. Protocol for the Management of Pregnant Women with Bacterial Vaginosis (Federal Clinical Guidelines). Akusherstvo, Ginekologiya i Reproduktsiya. 2015;9(4):29–36. Russian (Радзинский В.Е., Ордиянц И.М. Протокол ведения беременных с бактериальным вагинозом (Федеральные клинические рекомендации). Акушерство, гинекология и репродукция. 2015;9(4):29–36).
  4. Shekhtman M.M. Manual on Extragenital Pathology in Pregnant Women. Moscow: Triada-X; 1999. 816 p. Russian (Шехтман М.М. Руководство по экстрагенитальной патологии у беременных. М.: Триада-Х; 1999. 816 с.).
  5. Prilepskaya V.N., Bayramova G.R., Rogovskaya S.I., Govorova V.V. Modern Approaches to the Diagnosis and Treatment of Bacterial Vaginosis in Pregnant Women (Results of a Multicenter Study). Akusherstvo i Ginekologija. 2022;(5):116-123. Russian (Прилепская В.Н., Байрамова Г.Р., Роговская С.И., Говорова В.В. Современные подходы к диагностике и терапии бактериального вагиноза у беременных (результаты многоцентрового исследования). Акушерство и гинекология. 2022;(5):116-123).
  6. Sheshukova N.A., Kozlov P.V., Krupin K.V. Modern Features of the Course of Gestational Pyelonephritis. Akusherstvo i Ginekologija. 2020;(5):112–118. Russian (Шешукова Н.А., Козлов П.В., Крупин К.В. Современные особенности течения гестационного пиелонефрита. Акушерство и гинекология. 2020;(5):112–118).
  7. Smaill F.M., Vazquez J.C. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database of Systematic Reviews. 2019(11), CD000490. https://doi.org/10.1002/14651858.CD000490.pub4
  8. Hill JB, Sheffield JS, McIntire DD, Wendel GD Jr. Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005 Jan;105(1):18-23. doi: 10.1097/01.AOG.0000149154.96285.a0. PMID: 15625136.
  9. Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am J Obstet Gynecol. 2014 Mar;210(3):219.e1-6. doi: 10.1016/j.ajog.2013.10.006. Epub 2013 Oct 5. PMID: 24100227.
  10. Shkodkin S.V., Mozerov I.S., Zykov A.A., Kolesnikov G.M., Komarova V.S. Justification of Draining Interventions in Pregnant Women with Acute Gestational Pyelonephritis. Experimental and Clinical Urology. 2021;(4):88-92. doi: 10.29188/2222-8543-2021-14-4-88-92. Russian (Шкодкин С.В., Мозеров И.С., Зыков А.А., Колесников Г.М., Комарова В.С. Оправданность дренирующих вмешательств у беременных с острым гестационным пиелонефритом. Экспериментальная и клиническая урология. 2021;(4):88-92. doi: 10.29188/2222-8543-2021-14-4-88-92).
  11. European Association of Urology (EAU). Guidelines on Urological Infections. Limited Update March 2024.
  12. American Urological Association (AUA). Surgical Management of Stones: AUA/Endourological Society Guideline. 2016.
  13. Ministry of Health of the Russian Federation. Clinical guidelines: Urinary tract infection in pregnancy. 2025. ID: KR469. Russian (Министерство здравоохранения Российской Федерации. Клинические рекомендации: Инфекция мочевых путей при беременности. 2025. ID: КР469).
  14. Levchenko V.V., Ivanov D.D., Petrov S.B. Discussion Issues of Upper Urinary Tract Drainage in Pregnant Women with Acute Pyelonephritis: A Systematic Review of the Literature. Urology. 2020;(4):112–118. doi: 10.18565/urology.2020.4.112-118. Russian (Левченко В.В., Иванов Д.Д., Петров С.Б. Дискуссионные вопросы дренирования верхних мочевыводящих путей у беременных с острым пиелонефритом: систематический обзор литературы. Урология. 2020;(4):112–118. doi: 10.18565/urology.2020.4.112-118).
  15. Ministry of Health of the Republic of Kazakhstan. Clinical protocol «Antenatal Care» No. 185 dated 28.07.2023. Russian (Министерство здравоохранения Республики Казахстан. Клинический протокол «Антенатальный уход» № 185 от 28.07.2023).
  16. Ministry of Health of the Republic of Kazakhstan. Order No. KR DSM-10 dated October 20, 2020. Russian (Министерство здравоохранения Республики Казахстан. Приказ № КР ДСМ-10 от 20 октября 2020 г.).
  17. Deng T., Liu B., Duan X. et al. Risk factors and prediction model for ureteral stent-related symptoms in pregnant women with hydronephrosis. Transl Androl Urol. 2021;10(3):1215–1224.
  18. Lange D, Chew BH. Update on ureteral stent technology. Ther Adv Urol. 2009 Aug;1(3):143-8. doi: 10.1177/1756287209341306. PMID: 21789062; PMCID: PMC3126057.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Figure. Distribution of morbidity by trimester of pregnancy

Download (84KB)
Indexing metadata

Copyright (c) 2025 Bionika Media