Why is a kidney abscess so difficult to diagnose in time?

Kidney abscess is one of the most dangerous urological pathologies. This condition threatens the patient with severe, sometimes even fatal consequences, if this condition is not diagnosed in time and effective therapy is not carried out. Kidney abscess is one of the most common complications of urolithiasis, and the main difficulty in timely detection of this disease is that the clinical picture of a kidney abscess mimics the clinical picture of pyelonephritis. Therefore, a sufficient amount of knowledge about this condition and methods of its diagnosis and treatment is necessary for every practicing urologist.

Why can a kidney abscess occur

Kidney abscess is a form of acute purulent pyelonephritis. This is a limited purulent inflammation of the kidney, characterized by the melting of its tissues and the formation of a cavity filled with pus. Often, the formation of a kidney abscess is the result of a stone in the renal bowl or ureter, or surgery on the kidney for nephrolithiasis or its complications. Less commonly, a kidney abscess is formed as a secondary infectious lesion, when an infectious agent is hematogenously introduced into the kidney from other organs, in which case kidney damage is more often bilateral. A kidney abscess can break into the perirenal tissue, the caliceal system of the kidney or into the abdominal cavity, which threatens to develop serious complications up to the onset of sepsis.

How to recognize a kidney abscess: the clinical picture of the disease

The symptoms of a kidney abscess are very similar to the clinical picture of acute pyelonephritis. The disease begins acutely with a sharp increase in body temperature to hectic values ​​\u200b\u200band the appearance of acute pain in the lower back. Chills, rapid breathing and palpitations, symptoms of intoxication and intense thirst are observed. With bilateral kidney damage, symptoms of septic type intoxication predominate, and symptoms of liver failure also appear: icterus of the sclera and skin. It is quite difficult to distinguish a kidney abscess from other forms of pyelonephritis, since its clinical picture is not specific. To make a diagnosis, it is necessary to use additional diagnostic methods.

Laboratory and instrumental methods for diagnosing kidney abscess

The results of laboratory studies in a kidney abscess indicate the presence of an inflammatory process: leukocytosis is observed in the blood with a shift of the leukocyte formula to the left, an increase in ESR and acute phase proteins. Urinalysis may be unchanged, or give a slight increase in protein and bacteria. In the case of an abscess breakthrough into the renal bowl, pyuria is observed – pus in the urine. Plain urography provides information about the smoothness of the contour of the lumbar muscle and the protrusion of the outer contour of the kidney at the site of the abscess. Scintigraphy visualizes a filling defect in the localization zone of the kidney abscess. Ultrasound examination shows a kidney abscess in the form of a rounded formation with homogeneous contents and reduced echogenicity. The most informative diagnostic method for kidney abscess is computed tomography 

Methods of treatment and prognosis for kidney abscess

Conservative treatments for a kidney abscess are ineffective, as the abscess must be urgently removed before it breaks through to avoid serious life-threatening consequences. For this purpose, surgical intervention is performed: decapsulation of the kidney with a wide opening of the abscess, treating it with an antiseptic solution and draining both the abscess cavity and the retroperitoneal space. If there is a violation of the outflow of urine, the operation ends with a nephrostomy. In the postoperative period, the patient undergoes intensive antibacterial and detoxification therapy. The prognosis for the patient is favorable: with the timely diagnosis of a kidney abscess and its effective surgical treatment, a complete recovery occurs.