Pionephrosis - Causes, symptoms and treatment. MF.
Jun 17, 2018
Pionephrosis is the purulent fusion of the kidney tissue with the formation of an abscess. In this case, the kidney is a mixture of pus, parenchymal tissue, urine and, possibly, concrements. Pionephrosis is the final stage of purulent-inflammatory kidney disease.
Causes of pionephrosis
An immediate cause of pionephrosis is the pathogenic microflora, which affects the organo-pelvic organ system. As a result of her seeding, first an inflammatory and then a purulent process develops. Inadequate treatment or lowering of the body's immune defense, the purulent process quickly progresses and spreads. The tissues of the kidney, which are susceptible to purulent fusion, are affected. All that can in this situation make weakened immunity, it is to limit the process by surrounding tissues. As a result, a large abscess is formed, which is placed on the background of the former kidney.
The cause of primary infection of the kidney can be many. Most often, it is getting the infection through the urinary tract
Another cause of pyonephrosis may be a penetrating trauma to the lumbar region or the introduction of an infection by a blood stream from chronic foci. Chronic foci of infection in the human body, most often, are slow-progressive diseases of the ears, throat and nasal sinuses, which must be properly and correctly sanitized.
Symptoms of pionephrosis
The complexity of the clinical picture of pionephrosis is that it overlaps the symptoms of a previous disease. For example, pionephrosis develops after pyelonephritis, which is accompanied by very similar symptoms.
Kidney with pionephrosis
The general symptoms of pionephrosis are general, characterized by weakness, fatigue, sweating, pallor, and sleep disturbances. Along with this, local symptoms are clearly defined. For pionephrosis, characteristic signs are blunt pains in the lumbar region, which can give to the lower abdomen and the area of the external genital organs. A positive symptom of Pasternatsky is defined, in the form of pain intensification in the lumbar region with a slight tapping in this area.
Another characteristic for pionerophosis is the urinary syndrome. It manifests itself in the form of a change in urine. Visually, it is put muddy with a lot of flakes. If you allow urine to settle, then soon a sediment forms on the bottom of the glass, amounting to approximately 1/4 of the liquid.
So, if you notice a worsening of the general condition, a change in the color of urine or pain in the lumbar region, you should immediately contact the urologist for diagnosis and treatment.
Diagnosis of pionephrosis
Diagnosis of pionephrosis, like any other genitourinary system, begins with of general blood and urine analysis of .In the general blood test, there will be an increased number of leukocytes, shifting the leukocyte formula to the left with the appearance of plasma cells. In the general analysis of urine, there will also be a large number of white blood cells, as well as bacteria that are not present under normal conditions.
One of the specific methods for diagnosing pionephrosis is chromosystoscopy , which consists in the introduction of an intravenous solution of indigo carmine followed by examination of the bladder with an endoscope. With pionephrosis, there is a complete absence of solution from the affected side or rapid turbidity of the wash fluid.
At , the survey radiography of the abdominal organs in pionephrosis, it is possible to determine the shadow of an enlarged kidney and the absence of a contour of the lumbar muscle. When the excretory radiography is carried out, the contrast agent either lingers in the kidney or does not reach it at all.
For more accurate diagnosis, CT scan and ultrasound are currently used. With their help, you can determine the localization and nature of the pathological process in the kidney.
kidney ultrasound with pionephrosis
For the purpose of differential diagnosis of pionephrosis with a kidney tumor, is performed aspiration puncture biopsy under the supervision of ultrasound. After examination of the aspirate under the electron microscope, purulent detritus or atypical cells can be detected. In the first case, the results of the study indicate a pionephrosis, and in the second case - a malignant neoplasm.
Treatment of pionephrosis
The tactic of treatment of pionephrosis is the removal of a purulent focus. Most often an operation is performed to remove the kidney, which is called nephrectomy .If the patient's condition is very weak, the nephrectomy can be performed in two stages, the first of which is the operation to install a tube for urinary diversion, and the second is the immediate removal of the organ. If purulent destruction from the kidney passes to the ureter, then the procedure for removing the kidney and ureter - nephroureterectomy - is the technique of choice for the treatment of pionephrosis.
After the operative intervention the patient is prescribed a course of antibacterial therapy. It consists in the application of antibiotics to a broad spectrum of action. Among them, antibacterial drugs from the group of cephalosporins and fluoroquinolones can be isolated. For example, such drugs as cetrioxone and ofloxacin. But to apply them, because of many side effects, is recommended only after consulting a specialist.
Peculiarities of nutrition and lifestyle with pionephrosis
After the kidney removal operation, several tubes for drainage are put to the patient in the place of the postoperative wound. For the period of their wearing, patients are recommended careful treatment in order for the wound to heal adequately.
With regard to nutrition, as with any other kidney disease, with pionephrosis 7 dietary table for Pevzner is recommended. It consists in excluding the use of alcoholic beverages, coffee, strong tea, salty and acidic foods. Given that after the treatment of pionephrosis, the patient has only one kidney, dietary diet should be observed throughout the rest of his life.
Rehabilitation after the transferred pionephrosis
Since antibiotics are administered in large doses for the treatment of pionephrosis, patients need to restore normal intestinal microflora. For this, preparations containing normal bacteria are used. Such medicines as Hilak or Lactobacterin can be purchased at any pharmacy without a doctor's prescription.
In a remote period, patients are recommended to travel to resorts with mineral and mud treatment. Among such health resorts to date, the most popular are Saki and Morshin. Clinical studies show that those patients who regularly undergo courses of sanatorium treatment have a much lower risk of repeated purulent kidney disease.
Treatment of pionephrosis with folk remedies
Treatment with folk remedies in the early stages of the disease does not end with nothing but the progress of pathology. And if we talk about traditional treatment in later stages, then at this stage it can even be dangerous for life.
With kidney diseases all folk medicine, as a rule, recommends the use of diuretics and infusions of various herbs. With purulent inflammation, this can only promote general infection with serious consequences.
Complications of pionephrosis
Before talking about the complications of pionephrosis, it must be remembered that pyonephrosis itself is already a complication of such inflammatory kidney diseases as pyelonephritis, glomerulonephritis and others.
The most formidable complication of pionephrosis is sepsis. This medical term means a general systemic inflammatory reaction that develops due to the ingestion of a large number of toxic metabolic products into the blood. That is, in fact, with pionefroze, bacterial shock can develop.
Consequences of generalization of infection is the formation of metastatic abscesses in different organs. Most often, the liver suffers from abscesses, which in such a situation very quickly decompensates all organs and systems and leads to death.
There are local complications of pionephrosis. For example, if an abscess breaks into the pericardial tissue, secondary parainfur will develop, and if the abscess breaks out, the kidney fistula is formed. It should be noted that such fistulas, because of permanent urinary incandescence, have a very poor propensity to heal.
In addition, because of the increased burden on the second kidney, it can develop amyloidosis, a disease characterized by the deposition of the amyloid pathological protein in the renal parenchyma.
First of all, the prevention of pionephrosis should be aimed at preventing the occurrence of inflammatory diseases of the kidneys. The first point in this should be avoidance of hypothermia, which immediately affects the functional state of the kidneys.
An important point in the prevention of pionephrosis is the sanation of foci of chronic infection and adequate treatment of inflammatory diseases of the urogenital tract. For the sanation of foci of chronic infection, different methods of treatment are used. For example, if a patient has chronic sinusitis, consultation of an otolaryngologist is needed to carry out a sanitizing operation in the future.
Adequate treatment of inflammatory diseases of the urogenital tract consists in the timely administration of antibiotics to eliminate the infectious component of the disease. Prescribe antibiotics better by the results of a bacteriological study of blood and urine on the sensitivity of bacteria to antibiotics. If such a study is not possible, antibiotics of a wide spectrum of action are prescribed.
Prognosis of the disease
The prognosis for life is relatively favorable. With adequate timely treatment of pionephrosis, patients have a very good chance of recovery. The forecast for work is unfavorable, because even with professional timely treatment, patients are deprived of kidneys and receive a second disability group, which by law provides for a pension. The prognosis for recovery, as well as the prognosis for life, is relatively favorable. The chance of recovery appears in patients only at the early start of treatment. But even with such therapy, one does not have to count on preserving the kidney as an organ.
Rev.doctor urologist Astashin Е.Е.