pyonephrosis
Introduction
Introduction to renal empyema Pylephrosis, also known as pus and kidney, is an extremely severe renal purulent infection. The renal tissue is extensively destroyed, resulting in the formation of a pus and a loss of function in the whole kidney. basic knowledge The proportion of illness: 0.0015% Susceptible people: no special people Mode of infection: non-infectious Complications: abscess
Cause
Cause of renal empyema
(1) Causes of the disease
The disease is caused by obstruction of urinary tract stones, secondary infection is the most common; followed by renal and ureteral malformation caused by infectious hydronephrosis; secondary to pyelonephritis, pathogenic bacteria are more common with Escherichia. Renal tissue is severely damaged and all or part of the kidney becomes a purulent sac.
(two) pathogenesis
When the kidneys are infected and purulent, due to urinary tract obstruction, the pus can accumulate in the collecting system. When acute pyelonephritis with acute obstruction, it can be characterized by sudden fever, chills and low back pain, usually rapid. Development of sepsis, hydronephrosis, renal infection, development of suppurative pyelonephritis, if not diagnosed and properly treated, will lead to complete destruction of the kidney.
Occasionally, the kidneys with chronic obstruction have a resting onset when there is no obvious clinical symptoms. When the kidney is embolized, the patient shows fever, discomfort and kidney mass. If it is completely obstructed, the urine test will be normal.
Prevention
Kidney empy prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Renal empyema complications Complications
If the kidney is not treated in time, it can penetrate the renal capsule and form a peri-renal abscess.
Symptom
Kidney empyema symptoms Common symptoms Night sweats, cold war, low heat, weakness, high fever, vomiting
1. History: There is often a history of long-term renal infection or a history of kidney and ureteral calculi.
2. Symptoms: prominently manifested as pyuria, when the ureter and pus kidney are connected, there may be persistent gross pyuria, or intermittent pyuria, acute episodes, in addition to chills, high fever, general weakness, vomiting and other symptoms of systemic poisoning There are also obvious local symptoms, such as lumbar pain and lumbar muscle tension; if it is a chronic disease type, it is a chronic infection poisoning symptoms, such as low fever, night sweats, anemia, weight loss, etc., local symptoms are mild.
3. Signs: The kidney area is obviously tender and tender, and the waist can be swollen and swollen.
Examine
Examination of renal empyema
The white blood cells in the blood are obviously elevated. There are a lot of pus cells in the urine routine examination, and the urine culture is positive, but the urinary tract is completely obstructed as above, but the urine routine has no obvious abnormality, and the urinary bacteria culture can also be negative.
1. Cystoscopy: It can be seen that there is pus outflow in the ureteral orifice of the affected side.
2. X-ray examination: Abdominal plain film shows unclear kidney shadow, sometimes upper urinary calculi can be found, and intravenous urography shows poor or poor development of kidney.
3. Ultrasound examination: B-mode ultrasound examination can show liquid dark areas in the kidney.
4. CT examination: mixed density lumps with different shapes and blurred edges in the renal parenchyma, low density in the center, enhanced contrast showed that the renal parenchyma increased significantly, and the renal pelvis and renal pelvis were not developed.
Diagnosis
Diagnostic identification of renal empyema
diagnosis
Renal empyema and urinary calculi cause obstruction, secondary infection is the most common, followed by kidney and ureteral malformation caused by hydronephrosis, can also be secondary to pyelonephritis, pathogenic bacteria Escherichia coli is the most common, kidney The tissue was severely damaged and became a purulent sac. It is not difficult to diagnose according to symptoms, signs and imaging examinations.
Differential diagnosis
1. Acute pyelonephritis: mainly manifested as sudden chills, high fever, often accompanied by frequent urination, urgency, dysuria and other bladder irritation symptoms, but also low back pain and kidney tenderness, but the urinary tract irritation is severe. The pain in the kidney area was mild, and B-ultrasound examined the dark areas in the kidney. CT also had no low-density mass in the central area.
2. Peri-renal inflammation and peri-renal abscess: The main manifestations are chills, fever, severe low back pain and tenderness in the kidney area, but the urinary tract plain film shows that the shadow of the psoas muscle disappears. CT shows no mass of mixed density in the kidney. A lump is visible around the kidney.
3. Kidney tuberculosis: mainly manifests urinary frequency, urgency, dysuria and other bladder irritation symptoms, accompanied by low fever, fatigue, anemia and other symptoms of systemic tuberculosis and different degrees of pyuria, similar to chronic disease type renal empyema, but kidney The urinary frequency of tuberculosis patients is more serious. Acid-fast bacilli can be found in 24h urine sediment. The early renal tuberculosis IVU is characterized by irregular pelvis edge, such as worm-like shape. In the later stage, there is a sign of lack of one or several renal pelvis, tuberculosis. Kidney empyema is urinary rice soup-like turbidity, B-ultrasound can be seen in the kidney, but it is low fever, so it is also called cold abscess.
4. Hydronephrosis: mainly manifested as repeated low back pain, fever secondary to secondary infection, frequent urination, urgency, dysuria, similar to chronic course type renal empyema, but the body temperature of patients with hydronephrosis usually does not last Elevated, B-ultrasound showed that the liquid dark area of the kidney was more uniform than that of the renal empyema, and the CT examination showed a uniform density of the inner edge of the renal pelvis.
5. Kidney tumor: Sometimes it can be characterized by long-term low fever, low back pain, and similar to the chronic course of renal empyema, but there may be intermittent painless whole hematuria; IVU can see signs of renal pelvis, renal pelvis compression, deformation, etc.; CT showed a substantial mass in the kidney.
