Kidney pathologies are quite common in patients of any age and sex. The reasons for this are related to the fact that renal structures are very vulnerable to aggressive factors such as infections, hypothermia, chronic pathologies, etc. One of the most common renal pathologies is paranephritis.
Paranaphrite refers to pathological processes of inflammatory-purulent nature that affect the perineal lipid tissues. Most often, the provocateur of parainphritis is the E. coli, which penetrates into the cellulose through the ascending pathway.
In the international classification of diseases paranephritis was assigned the code for ICD-10 - N28.8.If the inflammatory lesion spreads across the entire area of the perineal cell, then talk about total paranephritis. If the front part of the organ is affected, then the front paranephrosis is diagnosed, and if the posterior part is inflamed, the posterior part is diagnosed.
Most often( in 80% of cases) the pathology has a secondary character, i.e. develops against the background of other pathological processes. Paranephritis is more often found in men than in women, and the peak is in 20-50-year-olds. But in elderly patients, this pathology is practically not found.
Forms and classification of
As already described, paranephritis can be: chronic and acute, purulent and acute purulent, primary and secondary. Primary forms develop due to the penetration of infection into the paranephric fiber from distant foci with blood flow, for example, in pulpitis, furuncle or sore throat, osteomyelitis, etc.
The development mechanism in this case can develop in several scenarios:
- Pus penetrates directly from the source( abscessor carbuncle of the kidney) into the parainal structures;
- Inflammatory components of purulent masses penetrate into the cellulose hematogenously or lymphogenically, for example, in the case of pyelonephritis;
- Infection penetrates from neighboring structures. This is the case with appendicitis, renal or pulmonary abscess and other pathologies.
Depending on the location, paranephritis is classified into the lower, front, upper, posterior and total. The most common type is a back and a left-sided type of pathology, since the lipid tissue is more developed precisely on the posterior kidney surface.
Risk Factors and Causes
Paranfetritis of any form never develops spontaneously, certain factors necessarily precede it:
- Diabetes mellitus;
- Pronounced urinary mucosa in cup-pelvic structures that occurs against the background of urinary tract obstruction;
- Dysfunctional urinary and neurogenic disorders;
- Inflammatory renal pathologies( especially acute pyelonephritis);
- Gram positive bacteria, Proteus, E. coli, staphylococci can provoke paranephritis;
- The risk of developing parainphritis includes people with low immune status and weak kidneys, as well as those who neglect treatment of renal inflammatory diseases;
- Primary parainfreight is rare and can occur against a background of mechanical traumatic injuries( often stabbing objects).Infection penetrates into the wound and safely develops in the paranephric tissues;
- Pathogenic microflora can penetrate into the cellulose with blood from other infectious foci. This often happens with cystitis and tonsillitis, cholecystitis, sinusitis, etc.
In immunodeficiencies, sepsis, or severe general overcooling, such complications, on the contrary, occur much more often. If acute paranephritis is treated with improperly selected antibiotics, the purulent-inflammatory process in the paranephalic structures undergoes chronicization.
Signs and symptoms
The pathology begins, as well as any other infectious inflammatory process in the urinary system - with the appearance of signs of an all-organic intoxication:
- The temperature rises sharply;
- There is soreness in the lumbar-kidney area;
- Rapid fatigue;
- Shortness of breath;
- Feeling of weakness and weakness;
- A urine appears in the urine, and its consistency acquires turbidity and cotton impurities.
A characteristic feature of the urine of patients with parainfritis is the three-layered urine - upon settling in urine, 3 layers are formed: renal detritus, purulent detritus and urine.
In general, the clinic of acute paranephritis has a pronounced character - the patient beats chills, worried about high temperature, the general condition worsens, there are painful manifestations in the kidneys, and in the lumbar region some swelling may form. Since painful symptoms affect the dorsal muscles, the flexion of the lower extremity in the hip and knee joint also generates a characteristic pain.
Clinical manifestations of chronic paranephritis are more worn out, but there are also characteristic of them, for example, dull tenderness in the lower back, hyperthermia and renal hypertension.
First, if a patient is suspected of paranphoritis, a laboratory diagnosis is made, including urine and blood tests. At the same time, the blood composition reveals the growth of ESR and redundancy of leukocytes, and in the urine the epithelium of the kidneys, the mass of bacteria and also the excessive content of leukocyte cells are detected.
Patients are also assigned ultrasound diagnosis of the kidneys. With paranephritis, this study identifies the presence of a fluid-like formation similar to a renal cyst.
Computer tomography is shown and performed, which provides more accurate visualization of purulent-inflammatory process in the paranephalic structures. For the final confirmation of the diagnosis, aspiration fine needle puncture biopsy with ultrasound or X-ray control is necessary.
To cure parainfrit at the initial stages, appropriate antibiotic therapy and detoxification treatment are prescribed, and anesthetics can additionally be prescribed. In chronic paranephritis, the use of complex conservative treatment, including anti-inflammatory therapy and antibiotic drugs, mud and paraffin applications, physiotherapy techniques is shown.
If the inflammatory process in peroneal cellulose is characterized by a purulent complication, then surgical treatment is required, involving the opening of purulent foci, followed by drainage. If paranephritis develops against the background of purulent renal melting, then the affected organ must be removed.
After surgery, a rehabilitation and rehabilitation period is required, involving a diet and spa treatment:
- During the post-operative treatment, the patient must take shock doses of antibiotic drugs to avoid inflammatory complications of the surgical wound. To do this, antibiotics are prescribed for the carbapenem or the fluoroquinolone group.
- With paranephritis, you must also comply with the dietary diet, which involves the rejection of salty and acidic dishes. In addition, you need to exclude and watermelons for their pronounced diuretic effect.
- Against the backdrop of powerful antibiotic therapy, a serious disturbance of the intestinal microflora occurs, so during the rehabilitation period, probiotics are administered to patients.
- Physiotherapeutic techniques such as thermal or ultraviolet action on the surgical intervention area are also used.
Post-operative treatment in a hospital lasts about two weeks, and outpatient therapy can last for six months.
Forecasts and complications of
In most cases, the predictions for paranephrine are positive, which is due to early diagnosis and a powerful therapeutic effect of modern antibiotic drugs. Forecasts of the chronic form of pathology are determined in accordance with the nature of the course of the renal inflammatory process.
The main direction of preventive measures against parainitis is the prevention of purulent-inflammatory renal diseases in the body cavity,for this purpose it is necessary to maintain the optimal immune status, to take vitamin complexes and periodically undergo sanatorium-resort treatment.
Paranephritis - up tostatistically dangerous pathology, in the absence of treatment which there is a real threat of death. Only correct and timely treatment will help to avoid unnecessary complications.