Pioneerphrosis

Pionephrosis is a disease that occurs as a result of active specific or nonspecific secondary pyelonephritis, characterized by purulent-destructive process in the kidney, purulent melting of the renal parenchyma and almost complete suppression of its functions.

Pinephrosis always accompanies peri-or paranephritis, intoxication of the body.

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Causes of the pionephrosis

Pionephrosis pathogens - Staphylococcus spp., Spreading hematogenically, but more often Escherichia coli, for which the ascending path is characteristic, tuberculosis pionephrosis is the final stage of kidney tuberculosis.

The risk factors for pionephrosis include urinary tract infection in history, urolithiasis, vesicoureteral reflux, diabetes mellitus, pregnancy, etc. Pionephrosis occurs more often in adults and elderly people.

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Symptoms of the pionephrosis

The patient's condition, as a rule, is extremely difficult.

The main symptoms of pionephrosis are: high fever, chills, low back pain. If there is no complete obstruction of the ureter (open pionerophosis), then with the bacteriological study of urine it is possible to isolate the causative agent of the infection. The urine is turbid, with a purulent precipitate.

In blood tests, hyperleukocytosis with a predominance of neutrophils. The kidney is palpable in the form of a dense sedentary formation, moderately painful. With obstruction of the ureter, the symptoms of intoxication grow particularly rapidly.

Diagnostics of the pionephrosis

When ultrasound is detected, the expansion of the cup-and-pelvic system filled with heterogeneous contents - fluid, pus, fragments of tissues. With urolithiasis, kidney or ureter stones are identified.

In the overview radiograph of the urinary tract, the shadow of the kidney is dense, enlarged, the contour of the lumbar muscle is absent.

With intravenous urography, there are no kidney functions, or after 1-1.5 hours and later there are shapeless shadows of the contrast medium in the cavity system

Significant help in diagnosing and pionerophosis may be provided by CT. With cystoscopy, the discharge of thick pus from the mouth of the ureter is determined ("as from a tube").

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Treatment of the pionephrosis

Pionephrosis - a state of emergency. Antibacterial and detoxification treatment is shown against this background. The operative treatment of pionephrosis, as a rule, consists in nephrectomy or nephreretheroctomy with obstruction of the ureter. In elderly patients with intercurrent diseases, the first stage often shows a palliative surgery - nephrostomy or percutaneous nephrostomy, followed by removal of the kidney after the improvement of the patient's condition.

Operative treatment of pionefroza has features. They are associated with the main process that causes the adhesion of the kidney to the surrounding organs and tissues.

When allocating the kidney, care should be taken not to injure adjacent organs - peritoneum, intestine, spleen, lower vena cava, etc. In some cases, with increasing kidney, apply a kidney puncture with aspiration of the contents. This reduces its size, facilitates its isolation and reduces the risk of sepsis, including bactero-toxic shock due to bacteria entering the blood.

Sometimes it is necessary to resort to subcapsular nephrectomy according to Fedorov.

In the postoperative period, intensive detoxification intravenous therapy with the introduction of various saline solutions, vitamins, haemodes, plasma, protein preparations is needed. Hemosorption, plasmapheresis, and hemotransfusion are also often shown.

The immediate and long-term results of surgery for pionefrosis are satisfactory, and the prediction of pionephrosis is quite favorable.