Timely diagnosis and elimination of infectious and inflammatory processes in the kidneys is one of the main tasks of all practicing urologists, since their prolonged course can lead to the formation of necrotic processes in the tissues of the kidney, which threatens the development of chronic renal failure and lifelong hemodialysis. One of these pathological processes is the carbuncle of the kidney – its purulent-necrotic lesion with the formation of a limited infiltrate in the cortical substance of the kidney. Kidney carbuncle can be of different sizes – from a few millimeters to more than 20 cm in diameter and requires immediate surgery.

Etiology and mechanisms of kidney carbuncle formation

Kidney carbuncle can be either one of the forms of purulent pyelonephritis, or it can occur as a secondary disease due to the ingestion of an infectious agent into the kidney by the hematogenous route. The most common causative agents of kidney carbuncle are Staphylococcus aureus, Proteus, and Escherichia coli. The mechanisms of kidney carbuncle formation are as follows:

  • entry into the renal artery of a septic embolus, which causes a septic infarction of the kidney and the occurrence of a carbuncle;
  • incomplete occlusion of a branch of the renal artery by an embolus and the development of an infectious process in it;
  • spread of infection from the site of its penetration into the kidney tissue, followed by its necrosis.

Clinical picture of carbuncle of the kidney: features of symptoms

Due to the fact that the carbuncle of the kidney can reach a large size and affect neighboring tissues and organs, its clinical picture is often disguised as a pathology of another localization: cardiovascular, digestive or nervous systems, thromboembolism or other kidney diseases, which greatly complicates the diagnostic process. A typical clinical picture of a carbuncle of the kidney is observed quite rarely. The disease can have both acute and latent course. Typical symptoms of kidney carbuncle include fever and chills, nausea and vomiting, and dull aching pain in the lumbar region. Often there is a clinic of an acute abdomen. Additional studies are needed to clarify the diagnosis.

Difficulties in diagnosis in the development of carbuncle of the kidney

The diagnostic process of kidney carbuncle is quite complicated, which is associated with the absence of specific signs of the disease. In less than 20% of cases, the correct diagnosis can be established before surgery. Laboratory tests indicate the presence of an inflammatory process in the body. Of the instrumental methods of diagnosis, an important role is played by X-ray examination: a decrease in the respiratory excursion of the diaphragm is determined and & nbsp; the presence of effusion in the costophrenic sinus. The most informative research methods for kidney carbuncle are ultrasound and computed tomography: kidney carbuncle is defined as a rounded formation with clear & nbsp; edges and individual echostructures in its cavity.

Surgical treatment of renal carbuncle: operation technique

Kidney carbuncle treatment is performed only by surgery. The kidney is released from its capsule and examined, since the nature of the surgical intervention depends on the depth of changes in the renal tissue. Above the cavity of the carbuncle, its shell is dissected and the carbuncle is cut out cone-shaped. If a significant amount of renal tissue is affected – remove this end of the kidney. In the postoperative period, the patient is prescribed & nbsp; antibacterial and detoxification therapy. If multiple carbuncles are found during the operation, a nephrectomy is performed.  With timely surgical intervention, a single carbuncle and the absence of urodynamic disturbances, the prognosis for the patient is favorable: a complete recovery is possible.

Add a comment

captcha

RefreshRefresh