What are these states?
All these forms are stages of one process. The infection enters the kidney ascendingly from the urinary tract or through the bloodstream from another source: boil, purulent wound, dental inflammation, endocarditis.
- Apostematous pyelonephritis - multiple small pustules in the renal cortex
- Kidney carbuncle - fusion of pustules into one large lesion
- Kidney abscess - a cavity formed with pus inside the kidney tissue
- Paranephritis - spread of pus into the fatty tissue around the kidney
- Retroperitoneal phlegmon - further spread of the process, the most severe option
Who's at risk
- Patients with diabetes are the most vulnerable group
- Urolithiasis, especially with ureteral obstruction
- Abnormalities of the kidneys and urinary tract
- Immunodeficiency conditions, taking immunosuppressive drugs
- Patients on dialysis and after transplantation
- Intravenous drug use
- Recent endoscopic surgeries and catheterization
- Pregnancy
- Old age
Symptoms
- High temperature with tremendous chills, difficult to respond to antipyretics
- Intense pain in the lower back and side
- Muscle tension in the lumbar region
- Increased pain when extending the leg in the hip joint - with involvement of the psoas muscle
- Severe weakness, sweating, lack of appetite
- Nausea and vomiting
- Increased heart rate, decreased blood pressure
- Sometimes - swelling, redness and tenderness of the skin in the lumbar region
- Changes in urine may be absent if the abscess does not communicate with the pyelocaliceal system
Diagnostics
- CT scan of the abdominal cavity with contrast is the main and most informative method
- Ultrasound of the kidneys is available and useful, but at an early stage purulent melting may not be detected
- Complete blood count: pronounced leukocytosis with a shift in the formula, increased ESR
- CRP and procalcitonin
- Blood cultures—mandatory for high fevers
- General analysis and urine culture
- Creatinine, electrolytes, glucose and glycated hemoglobin
- MRI with contraindications to contrast
- Search for the primary source of infection during the hematogenous route of infection
Treatment
The basic principle of purulent surgery is universal: the pus must be evacuated. Antibiotics alone cannot cure a formed abscess.
- Hospitalization and broad-spectrum intravenous antibiotic therapy followed by culture correction
- Percutaneous drainage of kidney abscess and paranephrism under ultrasound or CT control is the method of choice for a formed cavity
- Fine needle aspiration with antibiotic injection into the lesion
- Introduction of antibiotics into perinephric tissue
- Percutaneous nephrostomy or ureteral stenting for obstruction is a prerequisite for success
- Open surgery with opening and drainage - for extensive abscesses and phlegmon
- Kidney decapsulation for apostematous pyelonephritis
- Nephrectomy - in case of complete purulent destruction of the kidney and threat to life
- Infusion therapy, correction of glucose levels, treatment of sepsis
After recovery
- Long-term antibiotic therapy according to the prescribed regimen, including the period after discharge
- Follow-up CT or ultrasound to confirm resolution of the lesion
- Elimination of the cause: stone removal, correction of anomaly, treatment of prostate adenoma
- Strict control of diabetes is key to preventing recurrence
- Monitoring kidney function: creatinine, urine test
- Sanitation of other foci of infection
- Immediate treatment if fever and low back pain return
Where to contact in Tashkent
Purulent complications of pyelonephritis are treated only in a hospital: a round-the-clock CT scan, an operating room, the possibility of percutaneous drainage and observation by a resuscitator in severe cases are needed.
In Tashkent, such care, including drainage of kidney abscess and paranephria, is provided at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you are treating pyelonephritis, and the temperature persists for the third day despite an antibiotic, this is a reason not to change the drug yourself, but to urgently perform a CT scan. Clinic contacts are below on the page.
