What threatens the patient with the development of apostematous pyelonephritis

Pyelonephritis is one of the most widespread urological diseases. Women are more susceptible to pyelonephritis, which is associated with the peculiarities of the structure of the female urinary system, but men also often suffer from this disease quite often. Pyelonephritis can occur in two forms: acute and chronic. Acute pyelonephritis has several variants of the course of the disease, which depends on the nature of the damage to the kidney tissues. Apostematous pyelonephritis is one of the forms of acute pyelonephritis, which is characterized by the development of purulent-inflammatory processes mainly in the cortex of the kidney, and in the absence of effective and timely treatment can lead to the development of such a dangerous condition as urosepsis.

Etiology and morphological features of apostematous pyelonephritis

The causes of apostematous pyelonephritis are primarily infectious agents. Hematogenously, the infection enters the kidney tissue and develops primary apostematous pyelonephritis, which often affects both kidneys. Unilateral apostematous pyelonephritis develops when the disease is provoked by obstructive processes in the urinary tract. After undergoing surgical interventions on the kidney, apostematous pyelonephritis occurs as a secondary disease. Morphologically, with apostematous pyelonephritis, the kidney is enlarged, gray or cyanotic in color. Under the kidney capsule there are multiple small purulent foci - abscesses, up to several millimeters in size, which tend to merge.

Clinical picture of acute apostematous pyelonephritis

The disease begins acutely, more often after hypothermia or an infectious disease. There is an increase in body temperature up to 38-41 ° C, chills, heavy sweats, a decrease in blood pressure and impaired consciousness. In some cases, symptoms of liver failure appear - yellowness of the skin and sclera. With obstruction of the urinary tract, the clinical picture of apostematous pyelonephritis is dominated by symptoms of intoxication of the body: weakness, headache, nausea and vomiting. A few days later, pain syndrome joins: the pain is localized in the lumbar region, at first it is dull in nature, but it intensifies with time, which is associated with the involvement of the kidney capsule in the inflammatory process. Secondary apostematous pyelonephritis develops a few days after surgery,

Laboratory and instrumental methods for diagnosing apostematous pyelonephritis

The results of laboratory tests in apostematous pyelonephritis indicate the presence of an inflammatory process in the kidney: in the general blood test, leukocytosis is noted with a shift of the leukocyte formula to the left, an increase in ESR. In the analysis of urine, protein-, leukocyte- and bacteriuria are noted. Bacteriological culture of urine helps to identify the causative agent of the disease. More information about the nature of the pathological process can be obtained using instrumental research methods. Plain radiographs show an increase in the kidneys, while excretory urograms show a decrease in their functions. Ultrasound examination shows an increase in the kidney, thickening of its parenchyma and limited mobility, which indicates in favor of the inflammatory process. Thermography shows generalized hyperthermia on the side of the lesion.

Surgical treatment and possible consequences of apostematous pyelonephritis

Conservative treatment of apostematous pyelonephritis is ineffective - the disease requires urgent surgical intervention in order to preserve the viability of the affected kidney. By subcostal lumbotomy, the kidney is opened and decapsulated. Purulent foci are dissected and drained, as is the retroperitoneal space. If necessary, by creating a nephrostomy, a free outflow of urine is provided. Renal drainage should be maintained until the acute inflammatory process is completely eliminated. In the postoperative period, the patient undergoes antibacterial and detoxification therapy. With timely surgical treatment, the prognosis for the patient is favorable: complete restoration of kidney function is possible. With bilateral apostematous pyelonephritis, the mortality rate reaches 15%,