Paranephritis - Causes, symptoms and treatment. MF.

Paranephritis is a purulent-destructive melting of the perineal tissue, which develops as a result of the spread of the inflammatory process from the renal parenchyma. By its origin, paranephritis can be primary when inflammation begins directly in the cellulose, or secondary, when the purulent process passes from the kidney.

Causes of paranephritis

As it was already said, paranephritis begins as a result of the spread of purulent process from the kidney, and therefore the inflammatory diseases of this organ serve as the causes of parainfrit. Among such, first of all, one can distinguish acute pyelonephritis. It arises from the ingress of a pathogenic flora into the organ, which can occur in several ways: urinary, hematogenous or lymphogenic.

Important role in the development of paranephritis has the state of the immune system, the state of the kidney itself and the timeliness of the treatment of the inflammation of this organ. If even with excellent immunity and absolutely healthy kidneys, in time not to treat acute pyelonephritis, then it will necessarily go to pionephrosis and paranephritis.

Primary inflammation of the perineal cellulitis is a fairly rare occurrence. Most often this situation can be seen after a traumatic injury to the lumbar region, especially stitching objects. Infection, which enters the wound canal, develops well in the peri- kidney tissue. This leads to a rapid purulent inflammation and melting of the latter.

There are cases when paranusitis developed due to the contact spread of the process from the pelvic organs or the abdominal cavity. The most common causes of the disease were inflammation of the ascending or descending colonic guts, as they, like the kidneys, are in the retroperitoneal space.

Paranifrite development is also not excluded due to hematogenous spread of microbes from other organs. As the foci of infection may act chronic sinusitis, tonsillitis, cystitis or cholecystitis. The delay of microbes in the perineal cellulose is explained by the good vascularization of the latter.

Symptoms of paranaphrenitis

In the first place with paranephritis is the local clinical symptomatology, which manifests itself in pain in the lumbar region. Pain syndrome is noted both in a state of rest, and with a slight effleurage in this area. Palpation also marks a painful bulge in the area, which moves to the rhythm of breathing.

Together with the local, general symptoms develop. Patients complain of severe fatigue, general weakness, shortness of breath, sleep disturbance, weight loss. During the height of the disease, there may be a sharp rise in temperature to febrile numbers.

In addition, there are changes in the urine, which are manifested by a decrease in its number, cloudiness and the presence of a sediment with a large number of flakes. When the urine of the patient with parainfrit is upheld, three layers form in it. The first is renal detritus, in the second - purulent detritus and in the third there is actually urine.

Many patients who have chronic kidney disease neglect similar symptoms. In their situation, it is extremely important not to miss the moment of the transition of pyelonephritis to paranephritis. To do this, you should periodically be examined by a urologist or at least addressed to him in case of clinical symptoms that may indicate an inflammatory disease of the pericardial cellulose.

Diagnostics of paranaphrenitis

The first cases of patients with characteristic signs of parainfrit are assigned general tests of blood and urine. As a rule, an increased number of leukocytes with a shift of the leukocyte formula to the left and an increase in ESR are detected in the blood. In the general analysis of urine there is an increase in the number of leukocytes, the presence of renal epithelium and a large number of bacteria. All this leads to an increase in the specific gravity of urine.

Carrying out an ultrasonic examination makes it possible to determine the presence of a rounded formation filled with a liquid. It can be confused with a kidney cyst, so you need to pay attention to the clinical picture of the disease.

Para nephritis on uzi

Excretory urography, which involves X-ray examination of the kidneys after intravenous administration of contrast, makes it possible to determine impairment of the functional state of the kidneys. The same results are also noted during radioisotope renography.

Computer tomography, which is recommended to be carried out in the presence of appropriate equipment and facilities, gives more accurate results about the nature and localization of education.

A fine needle aspiration puncture biopsy is used for the final verification of the diagnosis. It is recommended to conduct it under the supervision of ultrasound or X-rays. It gives the most accurate results about the nature of the pathological neoplasm, which is located in the lumbar region.

Biopsy under the control of the uzi

Treatment of paranaphrenitis

For quick and effective recovery, patients are advised to conduct surgery in the hospital in the next time. The essence of the operation is to dissect the skin over the pathological protrusion and drain the abscess. If the cause of parainfrit was purulent melting of the kidney, the operation is complemented by the removal of this organ. The duration of the operation with paranephritis ranges from 1 to 3 hours, depending on the volume of the ulcer.

In the postoperative period, patients are given shock doses of antibiotics in order to avoid inflammation of the postoperative wound. Since this effect is difficult to achieve, strong antibiotics from the group of fluoroquinolones and carbapenems are used. They are released at the pharmacy at the doctor's prescription.

The period of the entire inpatient treatment is about two weeks, while the outpatient can be treated for up to six months until the nephrostomy is removed.

Treatment of paranaphrite with folk remedies

Treatment with folk remedies for paranephritis provides, as with any other inflammation, the use of local compresses. When superimposed on the area of ​​purulent melting of the warming compress, nothing is to be expected except spreading the process. Therefore, any kind of folk treatment is unacceptable with paranephritis. They can only delay the time that could be spent on effective traditional therapy.

Features of nutrition and lifestyle with paranonephritis

The special features of nutrition with paranephritis are that food does not exert additional stress on the single kidney that remains. This can be achieved by excluding from the patient's diet those foods that enhance the formation of urine. These are sour and salty dishes. With regard to salt, it must be tried at all to exclude or use in minimum quantities. Among the fruits you can not eat watermelons, because they have a fairly powerful diuretic effect.

Those patients who, after surgery, have to walk with the nephrostomy, that is, the urinary diversion tube, should be able to properly take care of it. It is important to carefully care for the urine receiver, because it can serve as a source of secondary infection of the operating wound. And as practice shows, those patients who develop secondary parainphritis have a very low survival rate. Therefore, for the nephrostomy, daily dressings and frequent tank changes are very important.

Rehabilitation after illness

Rehabilitation of patients after parainfritis, first of all, is to restore normal intestinal microflora, which is broken due to the use of a large number of antibacterial drugs. Their action affects not only the pathogenic, but also normal microbes, which is not a very pleasant fact for digestion. Therefore, all patients who have undergone an active course of antibiotic therapy are given probiotics.

Patients after parainfritation may subsequently be treated with physiotherapy. Among the most popular are ultraviolet irradiation and thermal effects on the postoperative field. Less effective, but not less popular is massage treatment, mud treatment and vibration therapy.

It is very important in rehabilitation to maintain the normal functional state of a healthy kidney, since it is now heavily loaded. This is possible with the help of the same diet or spa treatment.

Complications of paranaphrenitis

The most formidable complication of parainfritis is the hematogenous generalization of the process, in which pus from the local hearth spreads throughout the body. At the same time, the general symptomatology becomes aggravated and foci of purulent inflammation in other organs can arise.

An entire group of complications of parainfrit should be considered an autopsy of the abscess, which can occur in different cavities of the human body. When the abscess ruptures into the lumen of the intestine, the general condition is temporarily improved in patients. At the same time, the character of the chair changes. It can be liquid with an admixture of pus. A little later there is additional infection of the wound with calves, which leads to the emergence of a second wave of the disease.

When the abscess ruptures and the contents are evacuated into the abdominal cavity, abdominal pain, severe abdominal wall tension and positive symptoms of peritoneal irritation are noted in the patients. Such a clinical condition is referred to as an "acute abdomen" or peritonitis and requires immediate surgical intervention.

When the abscess is opened into the pleural cavity, there is a sharp soreness on one side of the chest and shortness of breath. A similar disease is called pyotorax, which means the presence of pus in the pleural cavity. It can be evacuated by puncturing the thoracic wall or through the surgical incision, which is more effective.

It is extremely rare to open the abscess outward, which is called a renal fistula. Treatment of such a complication consists in prolonged sanitation of the wound with permanent bandages.

Prevention of paresisphritis

The main direction in the prevention of parainitis is the prevention of purulent inflammation of the kidneys. This can be achieved by maintaining a normal level of immunity. Every year you need to rest on the seaside resorts and periodically take courses of vitamin therapy. Also, to control the level of immunity, it is necessary to periodically examine the immunologist to determine his immune status. Naturally, routine routine is not economically feasible, therefore such consultations are recommended only to those patients who have a tendency to colds or kidney pathology.

Rev.doctor urologist Astashin Е.Е.