Pyelonephritic abscess

　　What are the causes of kidney abscess

　　Common complications of kidney abscess include acute pyelonephritis, urinary tract obstruction, perinephric abscess, renal injury, perinephritis, and urinary tract infection.

　　If the treatment of kidney abscess is not timely, the pus can penetrate the renal capsule to form perinephric abscess or urinary source sepsis.

　　Kidney abscess is similar to perinephric abscess, and patients usually manifest as untreated acute pyelonephritis, with symptoms milder than perinephric abscess but with fever, elevated white blood cells, and lumbar pain. Urine culture is often positive, usually caused by Gram-negative bacilli, commonly Escherichia coli or Proteus, and blood culture is usually positive. The specific manifestations are as follows:

　　1, Fever:Sudden onset of chills, high fever, body temperature rising above 39℃, accompanied by headache, general pain, and nausea, vomiting. The fever pattern is similar to sepsis, with body temperature dropping after profuse sweating, and then rising again, lasting for about a week.

　　2, Lumbar pain:Unilateral or bilateral lumbar pain, with obvious renal area tenderness and costovertebral angle percussion tenderness.

　　3, Bladder irritation symptoms:Acute pyelonephritis caused by ascending infection appears with frequent urination, urgency, dysuria, hematuria at the onset, followed by systemic symptoms. Hematogenous infectors often start with high fever, and bladder irritation symptoms appear afterwards, sometimes not obvious.

　　The treatment of kidney abscess is very important, but the maintenance of each disease is also very important. Therefore, kidney abscess patients should pay attention to infection prevention in their daily lives to avoid aggravating the disease and pay attention to developing good living habits to improve resistance.

　　One, kidney abscess patients should bathe frequently, change clothes frequently, pay attention to the cleanliness and hygiene of the private parts, and avoid re-infection and aggravation of the disease.

　　Two, develop good sleeping habits, rest on time, and ensure sleep quality.

　　Three, kidney abscess patients should maintain certain physical exercise to enhance the body's resistance. However, attention should be paid to the combination of work and rest, avoiding fatigue affecting the body's resistance and反而 affecting the treatment effect.

　　Fourth, renal abscess patients must maintain smooth urination. Smooth urination can timely eliminate pus cells and pathogenic bacteria from the body, otherwise it will seriously affect the patient's treatment. If there are symptoms such as decreased urine output, drinking more water can be appropriately increased.

　　Fifth, the diet of renal abscess patients should be light, and any spicy food that can worsen the condition should be avoided. Avoid eating raw, hard, and cold foods. Do not eat foods high in sugar and fat. Of course, renal abscess patients should moderately supplement high-quality protein, vitamins, and other foods that can help patients resist the disease.

　　Sixth, maintain a good attitude. For renal abscess patients, it is necessary to have a good attitude, build confidence in overcoming the disease, and avoid affecting the treatment effect.

　　The laboratory tests that renal abscess patients need to do include:

　　1. Plain film

　　The renal shadow shows diffuse or localized enlargement, with unclear renal contours. The lumbar muscle shadow on the affected side is blurred, and the spine bends towards the affected side. In the chronic stage, the abscess wall can undergo calcification, appearing as punctate or curved lines.

　　2. Urinary tract imaging

　　Poor renal imaging or no imaging. If the abscess is localized within the renal cortex, the renal pelvis and calyces often show good imaging. Large abscesses can cause deformation of the calyces, appear indentation or incomplete filling, and the renal pelvis funnel can extend and straighten. If the abscess communicates with the renal pelvis, the abscess cavity can be displayed by venous or retrograde contrast imaging.

　　3. Renal arteriography

　　Diffuse abscesses are characterized by sparse renal vascular branches, with no obvious displacement of blood vessels and no new blood vessels. Capillary occlusion and arterial spasm in the inflammatory area result in slow blood flow. In the renal parenchyma phase, the renal shadow appears as patchy, with unclear interfaces between the cortex and medulla, and unclear contours of the renal cortex. In chronic abscesses, there is a lack of blood vessels or few blood vessels in the central area, and the thick-walled granulation tissue can show obvious new blood vessels.

　　4. CT

　　In the early stage, the abscess is characterized by limited enlargement of the renal volume, with a low-density area of similar shape visible locally, unclear boundaries, and mild enhancement after enhancement, which is significantly lower than the normal renal parenchyma. A non-enhanced area can be seen in the center. In the chronic stage, the lesion appears as low density on unenhanced scanning, with slightly lower or isodense changes at the periphery. After enhancement, the lesion presents as a ring-like enhancement, and the boundaries of the lesion are clearer than before enhancement.

　　A scientific and reasonable diet is conducive to the recovery of renal abscess patients. Therefore, renal abscess patients must scientifically match their diet in terms of food.

　　1. Control the intake of protein

　　Protein is an essential nutrient for the human body, but if the intake of protein is too high, it will increase the burden on the kidneys and exacerbate kidney damage. If the intake is insufficient, it will affect the nutritional supply of the body. Therefore, patients should decide the amount of protein intake according to the condition of kidney function. When there is no obvious kidney damage, the protein intake should be controlled at about 50g per day. If there are明显 abnormalities such as blood creatinine and urea nitrogen, the protein intake should be reduced to 20-40g per day.

　　2. Control the supply of calories

　　The appropriate amount of calories should be determined according to the condition, generally with maintaining an ideal weight as the standard. Due to the fact that such patients often have disordered lipid metabolism, reducing fat intake not only helps control calories but also improves metabolic disorders.

　　3. Ensure a low-salt, high-vitamin diet

　　Patients with hypertension and kidney disease should control the intake of salt, avoid salted food, and eat less food with preservatives. Adequate intake of vitamins, especially B vitamins, is beneficial for regulating body metabolism, and vitamin supplements can be taken if necessary.

　　Patients with renal abscess commonly have leukocytosis and pyuria. Many patients are most concerned about the treatment of renal abscess after suffering from it. Below, I will introduce several conservative treatment methods:

　　1. General treatment

　　Rest in bed, intravenous fluid therapy, drink plenty of water, maintain daily urine output of more than 1.5L, which is conducive to the excretion of inflammatory products. Pay attention to easy-to-digest, high-calorie, and vitamin-rich diet.

　　2. Antimicrobial drug therapy, the following drugs can be selected

　　① SMZ-TMP is effective against Gram-positive and Gram-negative bacteria except Pseudomonas aeruginosa.

　　② Quinolone drugs have a broad spectrum of antimicrobial activity, strong efficacy, and low toxicity. They are widely used in clinical practice except for children and pregnant women.

　　③ Penicillin drugs.

　　④ First and second-generation cephalosporins can be used for enzyme-producing Staphylococcus aureus infections. Second and third-generation cephalosporins have a significant effect on severe Gram-negative bacillary infections and have synergistic effects when used with aminoglycosides. Piperacillin, cefoperazone, cefotetan, amikacin, tobramycin, and others are effective for infections caused by Pseudomonas aeruginosa and other Pseudomonas species.

　　⑤ Nafcillin is suitable for Gram-positive bacterial infections in patients with methicillin-resistant Staphylococcus aureus, multidrug-resistant Enterococcus infections, and Gram-positive bacterial infections in patients with penicillin allergy. Imipenem-cilastatin sodium (Tigan) has a broad spectrum of antimicrobial activity and good杀菌 activity against Gram-negative bacilli. These are particularly suitable for refractory hospital-acquired infections and pyelonephritis in immunodeficient patients. The above treatment should be individualized, with a course of 7-14 days, and oral maintenance can be changed after the body temperature returns to normal, clinical symptoms improve, and urine bacterial culture becomes negative.

　　3. Symptomatic Treatment

　　Alkaline drugs such as sodium bicarbonate and potassium citrate can reduce the irritation of acidic urine to the bladder, thereby alleviating bladder irritation symptoms. Calcium channel blockers such as verapamil (isoptin) or flutamide hydrochloride (Urinary Ling) can relieve bladder spasm and alleviate irritation symptoms.