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Pyonephrosis
Last reviewed: 04.07.2025
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Pyonephrosis is a disease that occurs as a result of active specific or non-specific secondary pyelonephritis, which is characterized by a purulent-destructive process in the kidney, purulent melting of the renal parenchyma and almost complete suppression of its functions.
Pyonephrosis is always accompanied by peri- or paranephritis, intoxication of the body.
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Causes pyonephrosis
The causative agents of pyonephrosis are Staphylococcus spp., which spread hematogenously, but more often Escherichia coli, which is characterized by an ascending pathway, tuberculous pyonephrosis is the final stage of renal tuberculosis.
Risk factors for pyonephrosis include a history of urinary tract infection, urolithiasis, vesicoureteral reflux, diabetes, pregnancy, etc. Pyonephrosis occurs more often in adults and the elderly.
Symptoms pyonephrosis
The patient's condition is usually extremely serious.
The main symptoms of pyonephrosis are: high temperature, chills, lower back pain. If there is no complete obstruction of the ureter (open pyonephrosis), then a bacteriological examination of urine can isolate the infectious agent. The urine is cloudy, with purulent sediment.
Blood tests show hyperleukocytosis with a predominance of neutrophils. The kidney is palpated as a dense, slightly mobile, moderately painful formation. In case of ureteral obstruction, the symptoms of intoxication increase especially quickly.
Where does it hurt?
Diagnostics pyonephrosis
Ultrasound reveals expansion of the renal pelvis and calyces, filled with heterogeneous contents - liquid, pus, tissue fragments. In urolithiasis, kidney or ureter stones are determined.
On the general radiograph of the urinary tract, the shadow of the kidney is dense, enlarged, and the outline of the lumbar muscle is absent.
During intravenous urography, renal function is absent, or after 1-1.5 hours or later, shapeless shadows of contrast agent appear in the cystic system.
CT can be of significant help in establishing the diagnosis of pyonephrosis. Cystoscopy reveals the release of thick pus from the mouth of the ureter ("like from a tube").
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Treatment pyonephrosis
Pyonephrosis is an emergency condition. Antibacterial and detoxifying treatment are indicated against this background; surgical treatment of pyonephrosis usually consists of nephrectomy or nephroureterectomy in case of ureteral obstruction. In elderly patients with intercurrent diseases, palliative surgery is often indicated as the first stage - nephrostomy or percutaneous nephrostomy with subsequent removal of the kidney after the patient's condition improves.
Surgical treatment of pyonephrosis has its own peculiarities. They are related to the main process that causes the kidney to adhere to surrounding organs and tissues.
When isolating a kidney, care should be taken not to injure adjacent organs - the peritoneum, intestines, spleen, inferior vena cava, etc. In some cases, when the kidney is enlarged, a puncture of the kidney with aspiration of the contents is used. This reduces its size, facilitates its isolation and reduces the risk of sepsis, including bacteriotoxic shock due to bacteria entering the blood.
Sometimes it is necessary to resort to subcapsular nephrectomy according to Fedorov.
In the postoperative period, intensive detoxifying intravenous therapy with the introduction of various saline solutions, vitamins, hemodesis, plasma, and protein preparations is necessary. Hemosorption, plasmapheresis, and blood transfusion are also often indicated.
The immediate and long-term results of surgery for pyonephrosis are satisfactory, and the prognosis for pyonephrosis is quite favorable.