Pionephrosis is a serious purulent-destructive disease requiring surgical intervention. Operation is the only way to save a patient's life and at least partially restore health. Pionephrosis is the last stage of purulent-destructive pyelonephritis. It is characterized by purulent melting of the renal parenchyma and complete suppression of the functionality of the organ. The ailment always accompanies intoxication, peri- or paranephritis - purulent melting of the renal cellulose.
In pionephrosis, the kidney becomes a series of cavities filled with pus, urine, and necrosis products. Stagnation of infected urine causes the expansion of the cup-and-pelvis system, the parenchyma of the kidney is compressed and atrophied. Between the calyxes the parenchyma is replaced by the fatty and fibrous tissue, which leads to a noticeable narrowing of the anus of the calyx and pelvis. Thus, cavities with pus are formed.
Walls of pelvis are compacted, its size increases with extranal location. The
brain substance is most affected, most glomeruli and tubules are destroyed, sclerosis is observed. At later stages, atrophy of the brain substance begins. As a rule, the damaged organ has enlarged dimensions and resembles a thin-walled bag with retracted scars and dilated kidney cups.
The inflammatory process gradually passes to the ureter, which is accompanied by scarring and disturbances in the outflow of urine.
Several types of disease are distinguished:
- Open pionerophosis - pus from the parenchyma enters the ureter into the bladder and is excreted.
- Closed - in this case, outflow of urine from the affected kidney does not occur, as the inflammation led to tissue scarring and enlargement of the pelvis. The bladder receives only pure urine from a healthy kidney.
- One-sided - only one kidney is affected, left-sided or right-sided prionephrosis is the most common form of the disease. Damaged can be either right - right-sided, or left - left-sided pionephrosis. No definite regularity is observed in this case. However, in the first place, the kidney is damaged, where there are stones, an anomaly is observed, and so on.
- Two-sided - the defeat of both organs, fortunately, is rare.
The age range of the disease is not specific - from 30 to 50 years. In children, the disease is very rare, most often due to abnormalities of kidney development.
Code of the disease according to ICD-10 - N13.6. Kidney with pionephrosis
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Pionephrosis is the result of a combination of a certain active pathogenic factor and causative agent of the disease.
- The first is urolithiasis - such a pionephrosis is called calculous, tuberculosis of the kidney - tuberculosis pionerophosis, diabetes mellitus, organ trauma, malformations - dystopia, kidney doubling. However, most often the primary disease is pyelonephritis, and with improper treatment or even treatment.
- Pathogens - Staphylococcus aureus, streptococcus, tuberculosis mycobacterium and other pyogenic microbes. In the kidney infection can get with blood from the source of a chronic disease - most often it is a disease of the throat, ears. Another way is through the urinary tract with inflammation of the genitals or even using an unsterile urethral catheter.
Unlike hydronephrosis, whose symptoms are quite close, the root cause of pionephrosis is precisely the infection. In the parenchyma, the kidneys of the cavity with pus are formed as a result of an already active disease - pyelonephritis, for example, and getting the infection leads to inflammatory processes in the pelvis, which causes scarring of the tissues and violation of the outflow of urine.
The clinical picture of pionephrosis is similar to the symptoms of hydronephrosis, and in periods of relative well-being - with pyelonephritis. As a rule, the patient's condition can be described as moderate.
Obligatory symptoms are general intoxication:
- lethargy, fatigue, irritability;
- pallor of the skin, usually chills and sweating;
- with open pionefroze, the temperature is only slightly elevated. In acute course, fever and high fever occur.
Symptoms of the disease are also noted:
- Back pain - dull, aching, may be permanent or occur intermittently. When tapping in the lumbar region - Pasternatsky's test, the pain intensifies.
- By palpation, it is possible to detect an increase in the organ, its increased density and lack of mobility.
- The most characteristic sign of a disease is pyuria. Urine becomes turbid, a large number of flocs are released. When settling, a purulent precipitate is formed, occupying up to ¼ of the volume. In acute pionefroze, when there is obstruction of the urinary tract, the pus disappears, since only the urine from the healthy kidney enters the bladder. However, the temperature rises sharply, vomiting and nausea occur as a result of intoxication. The pain becomes much stronger, is given to the abdomen and groin area. There is a tachycardia. In this condition, urgent recovery of urine outflow is necessary.
Once the patency of the urinary tract is restored, the patient's condition improves noticeably.
With bilateral pionefroze, the picture is supplemented with symptoms of renal failure.
Important in diagnosing is the determination of the shape of pionephrosis. The disease itself is determined by palpation - it shows an increase in the kidney in size and the presence of a fibrous capsule, the release of pus from the ureter's mouth. Peculiarity of the disease - pyuria with an open form and the disappearance of this symptom in the obstruction of the urinary tract, is very characteristic.
Refinement is performed to assess the extent of the lesion and the state of the second kidney:
Diagnosis of pionephrosis
- In urine, a number of proteins, red blood cells and many microbes are detected in the urine.
- Bladder mucosa is almost not affected, but with cystoscopy from the ureter's mouth, thick pus is secreted.
- Overview radiography allows you to see the shadow of an enlarged kidney and the absence of the outline of the lumbar muscle.
- On the urography, the shadow of the kidney can not be obtained. Contrast substance either falls into the organ partially, or does not enter at all, respectively, receive a part of cavities or complete absence of a shadow.
- Retrograde pyelography provides the most accurate and complete information about the condition of the kidney and urinary tract. However, caution is necessary when conducting it, as the procedure requires the introduction of a contrast medium through the ureteral catheter, which can cause irritation and re-infection.
- ultrasound allows you to assess the degree of expansion of the bowl-and-pelvis system. The image clearly shows the heterogeneous contents of the cavities - pus, liquid, tissue particles.
- A specific diagnostic method for pionephrosis is chromosocystoscopy. The patient is injected intravenously with a solution of indigo carmine, and then the bladder is examined with an endoscope. When pyonephrosis from the side of the affected organ, the solution is completely absent or the liquid quickly becomes turbid.
The diagnosis of pionephrosis requires urgent intervention, more precisely, urgent surgical intervention. The medical treatment is aimed at improving the condition of the second kidney and the general condition of the patient.
The essence of drug treatment in this case is reduced to detoxification of the body and suppression of pathogenic microflora, which is prescribed antibacterial and detoxification preparations. Against the background of their admission and an operation is performed.
Pionephrosis is an indicator for surgical intervention, since, in fact, it acts as an extreme late stage of kidney damage. Folk remedies here are completely powerless and even lead to the spread of infection, since most such herbal decoctions are diuretics.
The use of infusions and decoctions at this stage can lead to extremely serious complications.
One of the characteristic features of pionephrosis is the adhesion of the kidney to surrounding tissues and organs. Accordingly, when it is allocated, extreme care must be taken not to damage the peritoneum, intestine, spleen and other internal organs. So, with a significant increase in the kidney, a puncture is first performed with aspiration of the contents in order to reduce the volume of the organ and facilitate its isolation.
- Most often resort to nephrectomy - the removal of the kidney. Under local or general anesthesia, the kidney is excreted from the fiber, squeezed and crossed by the ureter, artery and vein, the renal leg is bandaged and stitched. It is possible to carry out the operation in 2 stages: first install the tubes to remove urine, and then spend the allocation of the kidney.
- If the disease struck and ureters, prescribe nephroureterectomy - removal of both the kidneys and the ureter.
After the operation, a course of antibiotic therapy is prescribed. In this case, antibiotics of a wide spectrum are used - groups of cephalosporins and fluoroquinolones.
In bilateral pionefrosis, only bilateral nephro- or pyelostomy is possible-drainage of the kidney in order to excrete urine. Forecasts in this case are unfavorable.
Video on kidney removal nephrectomy:
Forecasts and complications of
In the course of treatment, that is, when the kidney is removed, the prognosis can be called favorable. Like all patients with a single kidney, such a patient must constantly be under the supervision of a urologist. As complications, the development of nephrolithiasis - the deposition of concrements or chronic inflammation of the kidney.
In the absence of treatment, the forecast is unfavorable. If the kidney is not removed, a chronic suppurative process causes amyloidosis of the second kidney, a breakthrough of pus in surrounding tissues, hepatopathy and so on.
In case of an unsuccessful course of the disease, a complication, such as sepsis, is possible. When a large number of toxic substances enter the blood, a systemic inflammatory reaction develops. It is possible the formation of abscesses in various organs, most often in the liver, which leads to a lethal outcome.
Less dangerous is the development of secondary paranephritis with a purulent breakthrough into the pericentular tissue. Also, a breakthrough of pus is possible - a renal fistula. The latter is very poorly healed, since urinary incursions are possible here. Features of the course of the disease
- With pionephrosis, or rather, after surgery, it is necessary to observe the 7 diet table. It excludes coffee, tea, alcohol, acidic and salty foods, as well as products that are too fatty and subjected to severe cooking: salting, drying, smoking, roasting. Observe the dietary table you need the rest of your life, because the patient has only one kidney.
- Postoperative treatment includes antibiotics in large doses, so later the patient needs to restore normal intestinal microflora. At the same time, such agents as lactobacterine or hilak are prescribed.
- Mud and mineral resorts are shown sick. According to statistics, regular treatment with mineral water reduces the risk of repeated purulent inflammation.
The prognosis after kidney removal is conditionally favorable. With full compliance with all recommendations and timely treatment, recovery is entirely possible, but this does not mean the restoration of efficiency, because even in the most favorable case the patient loses one kidney and receives a second group of disabilities.
Mortality immediately after surgery is 3-4%.However, if pionephrosis was a consequence of kidney tuberculosis, 30% of patients die within 6-12 months because of the processes taking place in the second kidney.
According to statistics, 32-43% of patients live at least 5 years after the operation.
Pionephrosis is a serious and very dangerous disease, leading to complete organ dysfunction. Treatment is possible only by surgery and reduces to isolating the injured organ.