Pyonephrosis is a severe suppurative infection of the kidney, with extensive destruction of renal parenchymal tissue and the formation of a large abscess cavity with the kidney. It can develop from uncontrolled progression of pyelonephritis, or from complications such as urinary tract obstruction and infection during the course of diseases like kidney stones, pyelonephritis, tuberculosis, hydronephrosis, and others. Pathologically, there is severe destruction of renal tissue, filled with a large amount of pus. Clinical manifestations may include systemic symptoms of infection and intoxication, such as fever and weakness during the acute phase, low-grade fever, weight loss, anemia, and renal area pain, tenderness on percussion of the renal area, enlargement of the kidneys, and blood tests showing an increase in white blood cells and left shift. Characteristic manifestations include purulent urine, which can be observed both grossly and microscopically.
But when urinary tract obstruction occurs, due to the inability to expel purulent urine, it is impossible to detect. At this time, based on the pathological changes of renal abscess, the renal tissue is widely destroyed, and the inside of the kidney is filled with pus, forming a large abscess cavity. Ultrasound should show a liquid-filled cystic structure, surrounded by the renal capsule, forming a nearly circular contour, with clear boundaries with the surrounding area. The inside of the cyst is anechoic, a liquid shadow area, which may be somewhat different due to the degree of lesion, that is, due to the degree of liquefaction. Some may have a small amount of tissue that has not been completely destroyed, or the purulent substance may be completely liquefied, appearing in different morphological medium-level echoes. The quality of ultrasound transmission in the abscess cavity is also affected by the state of the purulent substance.
3. What are the typical symptoms of purulent kidney?
1. The medical history often has a history of long-term kidney infection or a history of surgery for kidney or ureteral calculi.
2. The symptoms are mainly manifested as purulent urine. When the ureter is connected with the purulent kidney, there may be persistent gross purulent urine or intermittent purulent urine. In addition to systemic symptoms such as chills, high fever, general weakness, and vomiting in the acute attack type, there are also obvious local symptoms, such as pain in the lumbar region and lumbago.
3. Muscle tension is a stretch reflex caused by slowly and continuously pulling muscles. In a normal organism, even at rest, the skeletal muscles have a certain degree of muscle tension to maintain a certain posture; during activity, the muscles of the limbs also contract on a certain background of muscle tension. The spinal cord has more.
4. If it is a chronic course type, it presents with chronic infection and intoxication symptoms, such as low fever, night sweats, anemia, emaciation, and mild local symptoms. Signs include significant tenderness in the renal area, and the kidneys can be palpated as enlarged in the腰部.
5. What laboratory tests are needed for empyema of the kidney
Empyema of the kidney ultrasound diagnostic criteria:
1. The renal outline and shape on the affected side are lost.
2. The renal area is filled with a larger cystic structure, which does not contain any renal structure.
3. The cystic mass is an isolated structure, unrelated to surrounding organs.
4. It is necessary to exclude cystic diseases of the liver, gallbladder, spleen, pancreas, and adjacent organs and tissues.
7. Conventional Methods of Western Medicine for Treating Empyema of the Kidney
1. General supportive treatment such as rest, strengthening nutrition, and blood transfusion for anemic patients.
2. Rational use of antibiotics can select sensitive antibiotics based on the results of urine culture.
3. Early renal puncture and stenting, sufficient drainage, and observation of renal function recovery. If renal function recovers, correct the obstruction; if renal function cannot be restored, and the contralateral renal function is good, nephrectomy on the affected side should be performed.
4. If the abscessed kidney is too large and tightly adhered to the surrounding tissues, it may be difficult to remove the kidney. In this case, it is advisable to first perform nephrostomy drainage, and then perform nephrectomy later. In patients with chronic lesions, the renal cortex becomes a thin and atrophic fibrous sheath surrounding and filling the expanded urinary collection system with pus, so it is recommended to perform nephrectomy, starting from the obstructed segment of the ureter and removing the kidney and ureter together.
