Apostematous pyelonephritis is represented by a purulent-inflammatory process, in which the kidney cortex, many ulcers are formed. This pathology is considered a form of acute pyelonephritis.
With the Greek "Apostema" means an abscess, an abscess. With this pathology, many small abscesses appear in the cortical substance of the kidneys. Such suppuration of the parenchyma is considered a late stage of acute pyelonephritis.
This pathology has a bacterial etiology. Inflammation affects the tubular system of the kidneys, the renal pelvis.
Code of the disease according to the ICD - 10:
- №10.Acute tubulointerstitial nephritis.
- No. 11.Chronic tubulointerstitial nephritis.
- N12 Tubulointerstitial nephritis not specified as acute or chronic.
- N13 Obstructive uropathy and reflux-uropathy.
Usually the pathology under consideration develops in such types:
- Acute. It includes thr
ee forms: purulent, serous, with a mesenchymal reaction. Acute purulent form is characterized by the formation of ulcers on the kidney. In serous form lesions alternate with healthy parts of the body. The kidney is increased due to the presence of a perivascular infiltration( accumulation of cell elements, blood, lymph).The acute form with a mesenchymal reaction is characterized by leukocyte infiltration. Purulent in turn is divided into diffuse with abscesses, focal infiltrative, diffuse infiltrative. The development of this form of pyelonephritis can result in complete recovery of the patient. Also, the acute form with neglect of inflammation becomes chronic.
- Chronic. This form develops with neglect of acute pyelonephritis. The chronic form can be formed as an independent chronic process. This form is characterized by a slow flow, with the presence of periodic exacerbations. It is dangerous for the occurrence of sclerosis of the parenchyma, complicated hypertension, renal failure. Chronic apostematous pyelonephritis can occur in one of the following types: interstitial-vascular, interstitial-cell, sclerosing with shrinkage of the kidney, interstitial-tubular, with minimal changes, interstitial-tubular-vascular.
- Chronic with exacerbation. In this form, the features of the two above are combined.
Inflammation can affect one / two of the kidneys. Accordingly, 2 forms of the disease are isolated:
- one-sided. Inflammation affects only one of the paired organs. It occurs with obstruction of the urinary tract, when their function is disturbed;
- double-sided. Inflammation affects both kidneys, has a hematogenous origin.
Given the conditions of inflammation, specialists identify such forms of the disease:
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- Primary. There is inflammation on a perfectly healthy organ alone.
- Secondary. She is considered a consequence of one of many urological diseases. This form can manifest itself as an additional disease to the underlying pathology of the urinary system.
The foci of infection is located in the papules( ulcers) that appear on the cortical basis of the paired organ.
The appearance of apostematous pyelonephritis is facilitated by infection in the kidney.
Pathogenic microorganisms can penetrate in different ways:
- through the blood. Paired organs( kidneys) pump huge volumes of blood;
- through the genitals. Infection occurs through the bladder, the urethra.
Women, girls are more likely to face the disease we are considering. This is due to the feature that the fair sex does not have an elongated canal urethra. Pathogenic microorganisms quickly penetrate into the urea due to the short urethra.
Signs and symptoms
Disease is characterized by an increase in the kidney, which acquires a greyish-cyanotic color. Small purulent foci, whose size reaches 1 - 3 mm, are formed in a fibrous capsule of the kidney. In some cases, foci with abscesses merge. In the medullar substance of the paired organ, the radial location of the abscesses is noticeable.
Primary apostatial pyelonephritis begins abruptly. Pain is felt after fatigue, transferred infection, under hypothermia.
The patient has the following symptoms:
- high temperature( 38-410C);
- severe sweating;
- appears apathy;
- showed a decrease in blood pressure;
- occasionally appears ictericity( icterus, pigmentation) of the skin, sclera;
- delirium, hallucinations.
Initially, there is no change in urine. Then specialists discover leukocyturia, proteinuria, bacteriuria.
If the treatment is delayed for a long time, the patient is concerned about the increased pain. He has the rigidity of the muscles of the abdominal wall( their tone rises).
With secondary apostematous pyelonephritis, severe intoxication is rapidly developing. It manifests itself:
- adynamia( muscle weakness);
- general weakness;
- with vomiting;
- lowering blood pressure;
- with nausea.
On the 5th - 7th day with obstruction of the urinary tract there are such symptoms:
- reinforcement of low back pain;
- increased inflamed organ;
- pains when feeling the affected area.
To determine the exact diagnosis, experts recommend the passage of a comprehensive survey. The diagnosis is based on the following data:
- is anamnestic.
To determine the presence of pathology, diagnostic methods will help:
Signs of apostematous pyelonephritis on ultrasound
- Blood test. Experts take blood from the finger to compare the level of white blood cells, as well as from the waist( on both sides).Elevated levels of white blood cells will indicate the presence of lesions in one of the parties.
- Radiograph. It is carried out in the lumbar region and shows an increase in the kidney, lack / flatness of the contour of the lumbar muscle on the affected side, the presence of curvature of the spinal column. The X-ray shows the rim of the stimulation localized around the kidney.
- ultrasound. Visualizes the increase in the kidney, thickening of the pelvis wall, deformity of the calyx, thickening of the capsule, cerebral, cortical layers, the presence of hypogene foci in the parenchyma.
- Dynamic scintigraphy. It shows a violation of excretion, vascularization, secretion.
- Doppler. Shows the local union of the vascular pattern within the cortical layer.
- Urography. Helps detect the lack of mobility of the kidney during breathing. There is a deformity of the calyx, a decrease in urinary function.
- Tomography. It shows the thickening of the parenchyma, a decrease in the density of the paired organ.
Depending on the severity of the lesion, 2 therapies are used:
- Conservative treatment.
- Surgical intervention.
Therapy of the examined pathology is carried out in a stationary manner.
For fast recovery the patient needs:
- abundant drink;
- bed rest.
Antibiotics are prescribed unambiguously, but initially they are tested for susceptibility to microorganisms found in urine when carrying out a seeding tank.
To avoid the development of a chronic form, antibiotic therapy for a period of 6 weeks is performed. If apostematous pyelonephritis appeared against the background of another inflammation of the kidneys, the urinary system, the main disease is administered.
The first stage of treatment involves antibacterial therapy. Having removed an acute inflammation, specialists start treatment, which is similar to the treatment of chronic pyelonephritis.
For this use:
- Penicillins( "Azlocillin", "Carbenicillin", "Amoxicillin").
- Oxyquinolines( "Nitroxoline", "5-Knock").
- Cephalosporins( "Tsedeks", "Supraks").
- Sulfonamide preparations( "Biseptol").
- Fluoroquinolones( Norfloxacin, Levofloxacin, Ofloxacin, Ciprofloxacin).
- Nitrofurans( Furamag, Furadonin).
The main treatment for apostematous pyelonephritis involves surgery. Modern medicine has made available the latest technology, has opened up modern methods of surgical intervention.
In the treatment of the disease under consideration, specialists perform such actions:
- Kidney outbreak through lumbootomy.
- Decapsulation of this paired organ.
- Dissection of pustules.
- Draining of the retroperitoneal space
- Imposition of a nephrostomy to ensure free outflow of urine( if the passage is broken).
Kidney drainage is performed by installing a stent. Drainage is maintained until the patency of the urinary tract is restored. This procedure is mandatory for bilateral kidney damage.
The patient is recommended a gentle diet. He needs to drink about 3 liters per day. It is necessary to exclude from the diet products that accelerate the outflow of urea. The menu should be replenished with foods that contain a lot of carbohydrates, proteins. It is also recommended to take special "whey cocktails".
Prognosis unfavorable if the patient has a bilateral defeat. The probability of death is 15%.In addition, after performed organ-saving operations, sometimes severe complications arise( exacerbation of chronic pyelonephritis, shrinking of the kidney, stones, nephrogenic arterial hypertension).