A modern person is rather neglectful of his health. If you have back pain, then this is most likely overwork on a sedentary job. Temperature rise? Influenza and acute respiratory infections occur at any time of the year. Nausea and vomiting? Ate something stale. And so on. People sometimes refuse to accept the obvious: the body can fail, and sometimes you need to visit doctors to put yourself in order.
Definition
An abscess of the kidney is a severe form of pyelonephritis, which is accompanied by purulent fusion of the kidney tissue. A large lesion is formed during the fusion of smaller inflammatory elements, as well as during the formation of a carbuncle. A distinctive feature of this process is the presence of a capsule. It protects healthy tissues from active enzymes that dissolve everything that falls into the abscess area.
According to statistics, before the era of antibiotics, the main cause of the disease was hematogenous infection of the organ, but today it has faded into the background. The leading position in this top is a violation of the outflow of urine from the pyelocaliceal apparatus of the kidney. The fluid stagnates, becomes infected and suppurates, the inflammation passes to the renal parenchyma , where the fusion center is formed. With hematogenous spread, abscesses were found in both kidneys, and in case of violation of the outflow of urine - only in one.
Causes
A large number of pathological processes can cause kidney abscess. The reasons are usually associated with infection of the organ tissue. The presence of a carbuncle in the midst of pyelonephritis or a stone blocking the lumen of the ureter creates good conditions for the reproduction of bacteria. And like all living beings, they need to eat something, so they "attack" the organ parenchyma. In some cases, surgeons noted a kidney abscess after surgery for urolithiasis. At the same time, experts note a prolongation of the recovery period, the formation of fistulas between the ureter and the abdominal cavity.
Sometimes, if the abscess is localized at only one pole of the kidney, sequestration of this area occurs. This leads to irreversible morphological changes in the organ and a violation of its functions. In the medical literature, cases of the development of an abscess of the kidney after a knife wound are described. But in ordinary cases, the source of infection is located in the lungs or heart.
An already formed kidney abscess has several development options:
- Spontaneous opening in the perinephric fiber with the formation of a perinephral abscess.
- A breakthrough in the pelvis or kidney cups and drainage through the ureter.
- An autopsy in the abdominal cavity and the development of purulent peritonitis.
- Transition from acute to chronic.
Risk factors
For each disease, there are conditions under which there is an increased likelihood of the formation of a pathological process. For a kidney abscess, this is a history of diabetes, since this endocrine pathology exacerbates the course of all diseases and stimulates bacterial growth. And with diabetes, the formation of a large amount of urine is observed in patients, which also contributes to the infection in the kidney.
Pregnancy, as a variant of the physiological norm, can also provoke infection of the kidney tissue. Women during this period are especially vulnerable due to reduced immunity. In addition, they experience frequent urination, which facilitates the penetration of pathogenic bacteria.
In third place is pyelonephritis. What threat does he carry? Long, flowing with complications, pyelonephritis can result in a kidney abscess. Urinary tract obstruction provokes suppuration of the contents of the organ and the formation of foci of inflammation. And in an honorable fourth place - primary or secondary immunodeficiency. But the appearance of multiple purulent inflammations is a normal situation in this case.
Symptoms
How to clinically determine a kidney abscess? Symptoms at first resemble acute pyelonephritis, which can lead the doctor astray. Unfortunately, only a third of patients are correctly diagnosed before surgery. The disease begins with a rise in temperature to febrile numbers, breathing and palpitations become more frequent, pain appears in the lumbar region. But this is if the patency of the urinary tract is not broken, and the body continues to work.
If a kidney abscess is formed due to obstruction of the ureters, then patients have fever (under forty degrees), chills, tachycardia and frequent shallow breathing, thirst, headache, adynamia and pain in the projection of the kidneys. With the development of a bilateral process, patients experience symptoms of acute renal failure and severe intoxication.
Diagnostics
There are criteria by which to diagnose a kidney abscess. Ultrasound is considered one of the most reliable research methods for imaging abdominal organs. The specialist notes the following changes:
- areas of reduced density larger than a centimeter;
- uneven contours of the kidney;
- decreased passage of urine;
- general decrease in organ tissue density.
In addition, you can see the blood flow in the vessels of the kidney and make a contrast ascending urography. But the latter method is not as safe as ultrasound, because patients often have an allergic reaction to a contrast medium. An inflammatory reaction predominates in laboratory blood tests: an increased erythrocyte sedimentation rate (ESR), an increase in the number of leukocytes and neutrophils. Pus and blood are present in the urine, as well as bacteria that can be seen with microscopy.
Treatment
After all the research, the doctor needs to decide how to eliminate the kidney abscess. Treatment is usually surgical. Immediately after the diagnosis is made, the patient is taken to the operating room, where an abscess is urgently opened, the cavity is treated with antiseptic solutions and a drainage is inserted into it. Usually the pathological area is localized immediately under the capsule of the kidney, so the tone is well visualized.
The contents of the kidney abscess are sent for histological and bacteriological examination to accurately identify the pathogenic microorganism and determine its sensitivity to antibiotics. If the outflow of urine is impaired, then the surgeon forms a nephrostomy. After surgery, the patient continues to carry out enhanced antibiotic therapy and detoxification.
Recently, a new school of surgeons has been offering abscesses that are close to the surface of the kidney to drain by puncture, rinsing the cavity with a solution of antibiotics and staging drainage. But reliable clinical data on the effectiveness of this method is not.
Forecast
A kidney abscess is a serious illness of a vital organ, so even a small delay in treatment can be fatal. When conservative therapy is carried out, death is observed in almost seventy percent of cases.
Timely and sufficient surgical intervention can save the life and health of the patient. In such cases, they are guided by clinical symptoms and the conclusion of an ultrasound, all other tests are taken on the way to the operating room.
Prevention
You can prevent the appearance of a kidney abscess in a timely full treatment of pyelonephritis, especially if it is complicated by obstructive syndrome. Competent immunization, compliance with the recommendations of the doctor and the protective regime at home and in the hospital will help to avoid this formidable disease.