Kidney abscess-a limited purulent inflammation characterized by melting of the kidney tissue and the formation of a cavity filled with pus, is one of the forms of acute purulent pyelonephritis.
Etiology. A kidney abscess develops due to purulent melting of the parenchyma in the inflammatory infiltrate. In one case, granulation develops in the circumference of the focus of suppuration, which restricts it from healthy tissues, in others, the process spreads to the surrounding parotid fatty tissue, leading to the development of purulent paranephritis, in the third, the abscess is emptied into the renal pelvis, which leads to healing.
The clinic depends on the presence and degree of violation of the passage of urine. The body temperature rises hectically, chills, sweat, headache, vomiting are observed, pulse and breathing become faster, pronounced leukocytosis with a predominance of neutrophilosis. The absence of hyperleukocytosis is an unfavorable sign indicating a reduced reactivity of the body.
Diagnostics. The diagnosis is based on palpation of an enlarged painful kidney, a positive symptom of Pasternatsky, the presence of bacteriuria and pyuria, which can be significant when the abscess breaks into the renal pelvis. An overview image of the kidneys shows an increase in the size of the kidney and a bulging of its external contour in the area of localization of the abscess, on excretory urography – restriction of the mobility of the kidney at the height of inspiration and after exhalation, deformation or amputation of the kidney cups, compression of the renal pelvis.
On a retrograde pyelogram, in addition to these signs, when pus breaks into the renal pelvis, additional shadows are determined as a result of filling the abscess cavity with radiopaque fluid. On isotopic scintigrams, a vascular-free volumetric formation is detected, on echograms – a cavity in the area of a kidney abscess.
Surgical treatment: decapsulation of the kidney, opening of the abscess, drainage of the cavity; in case of violation of the passage of urine, the operation is completed with a pyelo-or nephrostoma.
Significant changes in the parenchyma are an indication for the removal of the kidney.
At the same time, antibacterial and detoxification therapy is carried out.