Kidney disease affects most of the population. This is facilitated by a genetic predisposition, an unhealthy lifestyle and an unwillingness to visit doctors at the first signs of the disease. Pus in the kidneys indicates a severe stage and neglect of the inflammatory process. Turbid exudate in the organs contributes to necrosis of its tissues, dysfunction and poses a serious threat to the whole organism.
A disease with such symptoms in urology is called pyonephrosis. Pathology is a big problem associated with high mortality (about 30%). Therefore, it is very important at the first clinical manifestations to seek medical advice.
What is pyonephrosis?
Pyonephrosis is the last stage of a purulent-destructive non-specific inflammatory process that affects the tissues and the pyelocaliceal system of the kidney (pyelonephritis). The disease can manifest itself at any age, but at most people from 30 to 50 years old suffer from it.
When pathogenic microflora enters the organ, tissue inflammation develops, vascular permeability increases, and pus appears in the kidneys. In the future, scars form, the extension of the pelvis of the bean-shaped organ occurs. The course of the pathology is aggravated by a hemodynamic disorder and a violation of the outflow of continuously produced urine. Pyonephrosis is characterized by purulent fusion of a functionally active epithelium (parenchyma) of the kidney and complete inhibition of its performance.
Pathology is a terminal stage of acute inflammation of the urinary tract and refers to urological diseases. Pyonephrosis according to ICD 10 has the code N13.6 and is assigned to the class of diseases of the genitourinary system.
The causes of the disease
The main factor influencing the formation of pathology is pyogenic bacteria that cause inflammation. The causative agent may be staphylococcus, streptococcus, E. coli, tuberculous mycobacteria. In addition, the development of the disease contributes to weak immunity or illiterate treatment of diseases of the urinary system of infectious genesis.
Pyonephrosis develops rapidly and forms cavities filled with turbid exudate, primary urine, and the remains of dead tissue. According to medical studies, the main causes of pus in the kidneys are:
- Infectious and inflammatory diseases of the urinary system. Pyonephrosis is the terminal stage of pyelonephritis, ascending urethritis, inflammation of the walls of the bladder, and tuberculosis of the kidneys. Incorrectly selected antibacterial drugs or non-compliance with medical recommendations contribute to the progression of the inflammatory process.
- Genitourinary malformations. Complete or incomplete doubling of the kidney or ducts of the urinary system, dystopia, fusion of the kidneys disrupt the normal movement of urine. Its stagnation is a favorable environment for the propagation of pathogens.
- Urolithiasis disease. The formation of stones in the kidneys or ureter prevents the normal passage of urine. Blood flow is impaired, which impairs immunity and increases the risk of infection.
- Pus in the kidneys may appear due to the use of a non-sterile catheter or due to damage to the walls of the urinary tract due to improper installation.
- Neoplasms in any of the pelvic organs. A cyst or tumor partially or completely blocks the blood flow, worsens the urodynamics and, as a result, the normal functioning of the kidneys.
- Lumbar injury. Due to severe damage, the anatomical integrity of the internal organs may be impaired.
Classification of pyonephrosis
A typology is formed on the presence or absence of a purulent lesion spreading to other organs of the urinary system. There are two forms of pyonephrosis:
- Open - products of purulent exudate from an inflamed organ through the ureter enter the bladder. Infection is detected during laboratory tests in a urinalysis.
- The closed form implies the presence of a capsule of connective tissue, which blocks the outflow of urine from the kidney. Laboratory tests do not reveal signs of pathology. In the absence of normal treatment, the closed form quickly becomes open.
Pyonephrosis is classified by location:
- One-sided - damage to only the left or right kidney, while a healthy kidney is exposed to an increased load with a gradual metabolic disturbance. This form is the most common.
- Bilateral - both kidneys are affected.
Complications of the inflammatory process have a statistical relationship with the age and gender of patients. Due to the anatomical features, women are five times more likely to suffer from pyonephrosis than the male half. In the latter, pathology most often develops against the background of prostatitis. By the way the kidneys in men hurt and the symptoms of a different nature, pyonephrosis and inflammation of the prostate cannot be confused.
Clinical manifestations
The severity of symptoms depends on how well the urinary tract function. If their work is disturbed, the signs of purulent intoxication intensify. These symptoms include:
- Strong temperature increase - up to 41 ° .
- Increased sweating.
- Reflex nausea, sometimes vomiting, resulting from acute renal failure.
- General weakness.
- Fast fatiguability.
- Paroxysmal headaches.
- Aching pain in the lumbar region, which intensifies during an exacerbation of the disease.
- Urine becomes cloudy with impurities of pus.
Against the background of exhaustion, immunity decreases, which leads to secondary infections - flu, stomatitis.
With pyonephrosis, differential diagnosis is important because of the similarity of the characteristic manifestations with polycystic kidney dysplasia. A similar clinic can be with tumors in a damaged organ. Both women and men have symptoms: kidneys hurt as with polycystic. General clinical signs are a palpable affected organ. But with polycystosis, both kidneys are palpated, since this disease is always bilateral.
What is the danger of pus in the kidneys, and what could be the consequences
The presence of turbid exudate is a serious danger to health and even life. Pyonephrosis in most cases is unilateral. An unaffected kidney works in an enhanced mode, while metabolism is rapidly disrupted. Complex protein-polysaccharide compounds are deposited in the kidney tissue, which violates the functionality of the organ.
Untimely seeking specialized help or the lack of adequate treatment leads to degeneration of renal tissue. Closed forms of pyonephrosis are dangerous by an increase in cavities containing exudate. The consequences of pus in the kidneys, which came out when the capsule ruptured, can be disastrous. The ingress of polymorphonuclear leukocytes, fibrin filaments, tissue proteolysis products into the abdominal cavity or into the retroperitoneal region leads to diffuse inflammation of the peritoneum, sepsis.
The kidneys maintain the acid-base balance of blood plasma, remove foreign compounds from the body. The presence of pus in the bean-shaped organ violates its functions, and the immune system weakens. Against this background, even minor colds quickly turn into severe pathologies.
Diagnostics
If the first symptoms of pus in the kidneys occur, you should visit a surgeon or urologist to undergo an examination. The doctor will conduct a physical diagnosis, which includes an anamnesis, palpation of the kidneys, palpation of the bladder. Suppuration makes the organ painful, changes its size. The surface of the kidney becomes heterogeneous, and the mobility of the organ in the retroperitoneal space is limited. Further diagnostics include general clinical, biochemical tests and instrumental studies.
Laboratory examination methods
To make a diagnosis, the following tests are required:
- General urine analysis. Urine turbidity, high white blood cell counts, the presence of bacteria, mucus, a specific protein are signs of inflammation in the kidneys.
- Clinical blood test. In the presence of an inflammatory process, the leukocyte count and ESR are high.
- Blood biochemistry. In people affected by the infection, the test reveals an increased content of urea and electrolytes. Increased creatinine levels indicate kidney failure.
- Bacteriological culture of urine. With the help of the study, the causative agent of the disease is identified and the type of antibiotic therapy is determined.
Instrumental diagnostics
Additionally required:
- Survey urography is an X-ray urological analysis that makes it possible to assess the size, configuration, position, uniformity of the structure of the kidneys and bladder.
- Ultrasound examination, which helps to detect the focus of inflammation in the affected organ, to establish its shape. If the scan will not be performed at the clinic, you need to find out how much an ultrasound scan of the kidneys costs. The price usually depends on the location of the clinic. So, for example, in capitals, the average cost of ultrasound is 2000 rubles.
- CT scan of the kidneys. It makes it possible to distinguish a purulent cavity from a cyst or other neoplasm.
- Dynamic nephroscintigraphy. It is necessary in order to evaluate the functionality of the kidneys, the stage of renal failure.
In some cases, angiography and chromocystoscopy are prescribed for a more accurate clinical picture.
Therapy
The treatment of pus in the kidneys is carried out exclusively by surgical methods. Drug therapy is prescribed as an auxiliary pre- and postoperative. There are two methods of surgical intervention.
- Nephrourerectomy is a procedure for removing the kidney, ureter and part of the urea. The method is used if the lumen of the lower section has narrowed and suppuration has formed because of this. An operation is performed by open access or using a laparoscope.
- Nephrectomy is a surgical method for removing a kidney. There are several types of nephrectomy: simple, partial (resection), total. The latter method is used only in the presence of a second healthy kidney. For the treatment of pyonephrosis, a resection is most often performed. With an open form of the disease, a scheduled operation is prescribed, with a closed one, emergency surgery.
After operation
Immediately after surgery to eliminate suppuration in the kidney, a course of antibacterial drugs is prescribed. Used third-generation antibiotics from the group of cephalosporins and fluoroquinines (Ceftriaxone, Levofloxacin). In parallel, to prevent intestinal dysbiosis, they drink drugs containing lactobacilli and bifidobacteria: “Hilak Forte”, “Acylact”.
Patients who have undergone surgery must adhere to the diabetes table number 7 throughout life. The diet excludes alcohol, fried, sour, salty foods, fluid intake is limited to 1.5 liters.
Physical activity after removal of the kidney is severely limited. Patients are shown spa and spa treatment using mineral water.
Forecast and preventive measures
With proper treatment and the implementation of all medical recommendations, the prognosis is favorable. But even with the best outcome, the patient is limited in working capacity, since he completely loses his body. The legislation provides for disability with a monthly cash benefit - compensation.
Based on statistics, about 43% of patients after surgery have been living for at least five years. Mortality immediately after surgery is 3-4%.
Prevention of pyonephrosis is focused on preventing the formation of infectious and inflammatory diseases of the genitourinary system. It is necessary to monitor a healthy kidney: take urine and blood tests, and conduct an ultrasound scan every six months. The examination can be done independently. To do this, you need to find out how much an ultrasound scan of the kidneys and laboratory tests cost, and after going through with the finished results, see a doctor.
In order to avoid pyonephrosis in the future, it is necessary to avoid hypothermia and timely and fully treat infections.