Abscess - purulent inflammation of the tissue, in which the tissues are melted and a cavity filled with pus is formed. Develop an abscess in any tissue: subcutaneous tissue, bones, muscles and internal organs, including kidneys. The cause of the disease are pyogenic bacteria that enter the body.
Kidney abscess
Kidney abscess - limited purulent inflammation, in which it breaks down - the parenchyma melts, and a purulent cavity forms on the damaged area. The cavity is surrounded by a granulation shaft, which prevents the ingress of pus into healthy tissues.
The disease is considered a form of acute purulent pyelonephritis, fortunately, very rare. Also, the cause may be abscessing of carbuncle - purulent necrotic lesion, or infection from other inflammation foci - in destructive pneumonia, for example. In the end, bacteria can be brought from inflamed urinary tract.
Drug treatment practically does not lend itself to medical treatment. When an illness is detected, an operation is usually given.
The ICD 10 code for the disease is N15.1.
Causes of
Purulent infection develops on the "prepared" site of the organ. As a rule, necrosis of the site occurs due to ischemia, and then, after getting the infection, a purulent cavity is formed. In this case, the inflammation passes into an abscess.
Various primary diseases can cause the disease:
- Acute purulent pyelonephritis is a serous or purulent inflammatory process. In fact, the second form is an abscess. Individual pustules that occur with pyelonephritis, merge, forming a large cavity in volume.
- Abscessed carbuncle - that is, joining the infection to an already existing purulent process.
- Urogenic pyelonephritis - bacteria enter the kidney through the renal papilla.
- Urolithiasis and stone removal surgery can provoke an abscess.
- Metastatic abscesses - in this case, the infection enters the kidneys through the blood from the lungs or heart.
- It is described cases when the cause of the disease was a knife wound of the organ.
As a rule, the abscess affects one kidney, bilateral inflammation( left or right) is rare.
Pathogenesis
The disease can develop in different ways, and in some cases it is possible to do without surgical intervention:
- The cavity is surrounded by a granulation shaft - this formation is relatively stable and easier to treat surgically.
- When accumulating an excessive amount of pus in the cortical area, the cavity of the cavity breaks down and contamination of the periphrene fat occurs. In this case, the abscess leads to purulent parainfrit.
- Pus from the cavity can enter the renal pelvis - this option leads to a cure without surgery.
- The abscess can enter the abdominal cavity - in this case, peritonitis develops.
- An abscess can take a chronic form. Its symptoms are identical to the symptoms of a tumor in the kidney.
Kidney abscess and peritonitis as a consequence of autopsy can cause sepsis - a generalized infectious disease of the blood. The spread of sepsis is caused by a variety of reasons - from the violation of immunoreactivity to the wrong choice of drug therapy.
Signs and Symptoms of
The disease is diagnosed with great difficulty, since its symptoms are almost identical to any septic disease. Against this background, signs indicating damage to the kidneys are invisible. According to statistics, the diagnosis of kidney abscess is established only in 28-36% of patients.
The clinical picture to a large extent depends on the nature of the ailment and the location of the abscess in the organ.
If the abscess does not affect the ureter, then only signs of intoxication and general inflammation are observed: the
- temperature rises rapidly to 38-40 C;
- strong shaking chill;
- hot flashes of sweats - as a rule, each of them indicates the appearance of abscess;
- decreased blood pressure;
- weakness, lack of appetite, tachycardia - usual symptoms of intoxication;
- the outflow of urine is not difficult, pain does not cause;
- a pain in the lower back is possible.
If the abscess develops against a background of urolithiasis or makes it difficult to drain urine, the patient's condition deteriorates noticeably.
Symptoms that are specific for sepsis appear:
- severe pressure reduction, increased heart rate;
- vomiting, persistent strong thirst;
- adynamia - a decline in strength, accompanied by the cessation of any muscle activity;
- noisy, frequent - "pounded" breath;
- also joins oliguria, which only increases the general intoxication.
Rarely, but there is also a bilateral kidney abscess.
In this case, there are pronounced signs of renal and hepatic insufficiency:
- pallor, skin swelling, edema;
- hematuria - there is blood in the urine;
- oliguria,
- marked jaundice of the skin and sclera.
Pasternatsky's test gives a sharp response. With palpation, the kidney feels that it is enlarged in size, very painful. If the abscess is located in the organ closer to the abdominal cavity, there are symptoms of "acute abdomen" - muscle tension and tenderness when pressing.
Diagnostics
The most informative in this case are the instrumental methods of investigation. However, they are not universal, as indicated by a high proportion of erroneous diagnoses - almost 40%.
General blood and urine tests are mandatory:
- in the blood there is an increase in the number of leukocytes - the standard reaction in inflammatory processes. It is possible to increase ESR;
- in urine find traces of albumin, a small amount of red blood cells - at the stage of hematuria;
- can be observed as a lack of white blood cells in the urine, and an increase in their number - more than 30000 / μL;
- if the abscess is in contact with the calyx, then a huge amount of microorganisms is found in the colored sediment.
Instrumental methods in this case are more informative, although they do not give a 100% accurate answer:
- The first, as a rule, is used ultrasound in view of high safety. With an abscess, uneven contours are detected, hyperechoic foci are formations with subcutaneous contents. If such changes are identified, CT is also additionally assigned with a contrast agent.
- Computed tomography( CT) can accurately localize lesions. In the kidney, foci of reduced accumulation of contrast medium are noticeable - with an attenuation factor of up to 30 HU.Thus fix and single, multiple abscesses.
- Overview urogram - X-ray examination covering the entire urinary system. With an abscess, the picture shows a curvature of the spine, absence of a shadow of the lumbar muscle, there is an increase in the kidney and swelling on the side of the lesion.
- Excretory urography allows to fix squeezing of pelvis and calyx. Thus, the decrease in the functionality of the kidney is determined up to complete cessation. With an abscess the kidney is fixed and does not have respiratory mobility. The excretory urogram must be prescribed, if it involves surgery.
- Retrograde pyelogram, in addition to all of the above, indicates signs of a breakthrough of pus in the pelvis - additional shadows appear.
- Isotopic scintigram - the abscess here looks like an avascular volumetric formation.
Helps to establish the diagnosis of the use of micro-preparations and macro-preparations. The latter is a sample of damaged tissue with all its features. The drug allows you to detect the difference between borderline states and clarify the diagnosis. To determine the kidney abscess, use the O / 20 micropreparation.
Endoscopic research methods are prohibited - the risk of secondary infection is too high.
Treatment
Kidney abscess is classified as a disease requiring immediate surgery. As the statistics show, in the treatment with pharmacological methods or with the help of phytotherapy in 75% of cases leads to the death of the patient. Exceptions are cases when pus from the cavity is emptied into the pelvis and is excreted through the urinary system.
Folk remedies
In this case, the treatment of folk remedies, in particular herbal preparations, is either powerless or harmful. External application - lotions and compresses, have no effect, since the abscess is in the internal organ.
Conservative treatment of
Medication is used only at the initial stages of the disease. Its essence boils down to the reception of antibiotics that suppress the microflora. Unfortunately, this is not very effective, since antibiotics can cope with only a part of the bacteria. And quite definite, and without knowing the exact composition of pus, this is difficult to determine.
Surgical intervention
The level of intervention depends on the severity of the disease. Modern technologies in some cases allow us to do without cavitary surgery.
Percutaneous puncture with drainage. To the affected parts of the kidney drainage is led and pus out. Pus is transferred for analysis to establish the composition of microflora and its sensitivity to antibiotics. According to these data, preparations are selected and the cavities washed. The drainage itself is constantly washed with saline solution.
This solution is suitable for multiple abscesses with contents in the form of a thin fluid.
Surgical intervention - is shown in most cases, especially with multiple ulcers or a later stage of the disease.
The order of the operation is as follows:
- opens the fibrous capsule in which the kidney is located. The capsule does not stretch, therefore, in inflammation, the kidney that has increased due to the edema is compressed in the capsule, which leads to the appearance of painful symptoms. The capsule is cut and removed;
- the abscess is opened - as a rule, it settles down under a capsule of a kidney and is well appreciable. If the abscess is located deeper, then from its side the swelling is visible. The cavity is opened, cleaned of pus and disinfected with antiseptic drugs. Disinfection is also subject to lying tissues;
- is installed drainage into the cavity and retroperitoneal space. Drainage removes pus from the kidney and prevents the appearance of a new one until the infection is completely suppressed;
- pus from the cavity is transferred to the study in order to establish its composition and sensitivity to drugs. Thus, the drugs necessary for further treatment are determined;
- if the abscess appeared on the background of urolithiasis and the patient's condition allows, then at the dissection of the abscess the stones from the bladder and ureter are also removed in parallel. If the patient's condition is severe, then the removal of stones is postponed for 1.5-2 months, until the kidney state stabilizes;
- for normal outflow of urine set nephro-pylistoma. After the treatment is completed, the urinary fistula is healed.
With significant organ damage, kidney removal is prescribed.
With a timely diagnosis and a competently performed operation, the prognosis is favorable. However, if the primary disease is treatable with great difficulty, it is likely the appearance of a secondary abscess. The patient must be under supervision of a nephrologist and urologist after treatment.
Kidney abscess is a dangerous and serious disease that leads to death in the absence of treatment. Diagnosis of it is difficult, the main method of treatment is surgical intervention.