Modern man is rather careless about his he alth. If there are back pains, then this is most likely overwork at a sedentary job. Temperature increase? Influenza and acute respiratory infections occur at any time of the year. Nausea and vomiting? Ate something stale. And everything like that. People sometimes refuse to accept the obvious: the body can fail, and sometimes you need to visit doctors to put yourself in order.
Definition
Abscess of the kidney is a severe form of pyelonephritis, which is accompanied by purulent fusion of the kidney tissue. A large focus is formed in the process of confluence 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 he althy tissues from active enzymes that dissolve everything that has fallen 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 occupied by a violation of the outflow of urine from the pyelocaliceal apparatus of the kidney. The fluid stagnates, becomes infected and suppurates,inflammation passes to the parenchyma of the kidneys, where the focus of fusion is formed. With hematogenous spread, abscesses occurred in both kidneys, and in case of impaired urine outflow, only in one.
Reasons
A large number of pathological processes can cause a kidney abscess. The causes are usually associated with infection of the organ tissue. The presence of a carbuncle in the midst of pyelonephritis or blockage of the lumen of the ureter with a stone creates good conditions for the reproduction of bacteria. And like all living beings, they need something to eat, so they "attack" the parenchyma of the organ. In some cases, surgeons have noted a kidney abscess after surgery for urolithiasis. At the same time, experts note a lengthening of the recovery period, the formation of fistulas between the ureter and the abdominal cavity.
Sometimes, if the abscess is localized only at one pole of the kidney, sequestration of this area occurs. This leads to irreversible morphological changes in the organ and disruption of its functions. In the medical literature, cases of the development of a kidney abscess after a stab 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 into the perirenal tissue with the formation of a perirenal abscess.
- Breaking into the renal pelvis or calyx and draining through the ureter.
- Opening into the abdominal cavity and the development of purulent peritonitis.
- The transition from the acute phase tochronic.
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 mellitus, since this endocrine pathology aggravates the course of all diseases and stimulates bacterial growth. And with diabetes in patients, the formation of a large amount of urine is observed, which also contributes to 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 have frequent urination, which makes it easier for pathogenic bacteria to enter.
In third place - pyelonephritis. What threat does he pose? Prolonged, flowing with complications, pyelonephritis can result in a kidney abscess. Obstruction of the urinary tract 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 identify a kidney abscess? Symptoms at first resemble acute pyelonephritis, which can mislead the doctor. Unfortunately, only in a third of patients the correct diagnosis is made before surgery. The disease begins with a rise in temperature to febrile numbers, breathing and heartbeat become more frequent, pain appears inlumbar region. But this is if the patency of the urinary tract is not impaired, and the organ continues to work.
If a kidney abscess is formed due to obstruction of the ureters, then patients experience fever (under forty degrees), chills, tachycardia and frequent shallow breathing, thirst, headache, weakness and pain of the projection of the kidneys. With the development of a bilateral process, patients experience symptoms of acute renal failure and severe intoxication.
Diagnosis
There are criteria by which a kidney abscess can be diagnosed. Ultrasound is considered one of the most reliable research methods for visualizing the abdominal organs. The specialist notes the following changes:
- areas of reduced density larger than a centimeter;
- irregular contours of the kidney;
- decreased urine passage;
- general decrease in organ tissue density.
In addition, you can see the blood flow in the vessels of the kidney and make contrast ascending urography. But the latter method is not as safe as ultrasound, because patients often have an allergic reaction to the contrast agent. In laboratory blood tests, an inflammatory reaction predominates: an increased erythrocyte sedimentation rate (ESR), an increase in the number of leukocytes and neutrophils. The urine contains pus and blood, as well as bacteria that can be seen under microscopy.
Treatment
After all the research, the doctor needs to decide how to eliminate the abscesskidneys. Treatment is usually surgical. Immediately after the diagnosis is made, the patient is taken to the operating room, where an abscess is urgently opened, its cavity is treated with antiseptic solutions and a drain is inserted into it. Usually the pathological area is localized just below the kidney capsule, so the tone is well visualized.
The contents of the kidney abscess are sent for histological and bacteriological examination in order to accurately identify the pathogen and determine its sensitivity to antibiotics. If the outflow of urine is disturbed, then the surgeon forms a nephrostomy. After the operation, the patient continues to receive enhanced antibiotic therapy and detoxification.
Recently, a new school of surgeons is suggesting that abscesses that are close to the surface of the kidney be drained by puncture, flushing the cavity with an antibiotic solution, and setting up a drain. But there is no reliable clinical data regarding the effectiveness of this method.
Forecast
Kidney abscess is a serious disease of a vital organ, so even a slight delay in treatment can be fatal. With conservative therapy, almost seventy percent of cases are fatal.
Timely and sufficient surgical intervention can save the life and he alth of the patient. In such cases, they are guided by the clinical symptoms and the conclusion of the ultrasound, all other tests are taken on the way to the operating room.
Prevention
Prevent kidney abscesscan be timely full treatment of pyelonephritis, especially if it is complicated by obstructive syndrome. Competent immunoprophylaxis, adherence to the recommendations of a doctor and a protective regimen at home and in a medical institution will help to avoid this terrible disease.
