Pyonephrosis is a disease caused due to collection of pus in kidney parenchyma. It is also known as renal abscess. It is an uncommon disease which causes destruction of nephrons; the kidney’s important collecting system. The main etiological factors are bacterial infection in upper urinary tract area and obstruction usually caused due to a stone.
The risk of pyonephrosis increases in people suffering from diabetes, compromised immune status and anatomically misshaped kidney such as horseshoe shaped kidney. Fever, rigor, pain in flank, palpable bulge in abdomen area, vomiting, are some of its clinical symptoms.Pyonephrosis is a serious condition. If not treated on time can lead to sepsis and death.
What Are The Causes Of Pyonephrosis?
Pyonephrosis is a rare disease of kidney. It occurs due to collection of pus and formation of abscess in the collecting system of kidneys. The prominent reason of pyonephrosis is infection in the upper renal tract and obstruction. E.coli, Klebsiella, proteus, Candida, etc are the usual infective pathogens that may be responsible for infection and damage to the renal tissue.
Obstruction can occur due to various reasons such as stone in kidney, metastatic tumor arising from cancer of testis and colon.Obstruction can also occur at the junction of ureter and renal pelvis due to compression of growing uterus in pregnancy etc.
Past history of kidney surgery and chronic infection of kidney can also lead to formation of renal abscess. People with weakened immunity such as patients of HIV or diabetics are at greater risk of developing pyonephrosis due to infectious agents.
Signs And Symptoms Of Pyonephrosis
Pyonephrosis usually develops as a combined pathology of obstruction in urinary tract and infection in the renal parenchyma. Hence the symptoms of both this conditions are present in pyonephrosis. The clinical symptoms of patients may vary, but fever, shivering, and pain in flank are three distinctive features.
Along with these three symptoms, pyuria is present in almost all cases of pyonephrosis. Pyuria is passage of pus in urine. There may be accompanying nausea and vomiting. Pain may also be present on in the lumbar region of the back. On examination of abdomen a palpable lump may be detected due to enlargement of kidney as a result of abscess. It may cause kidney failure.
If the condition is untreated, pyonephrosis may lead to sepsis a life threatening condition, especially in immune compromised people. With usual symptoms of sepsis such as rapid heart rate, rapid breathing, abdominal distension, pale skin, low blood pressure, etc patient may go into septic shock and die.
Diagnosis And Treatment Of Pyonephrosis
A proper medical history and clinical examination assisted with laboratory tests are useful in diagnosing the condition. CT scan and ultrasonography are important radiological tools for diagnosing pyonephrosis. The doctor will also recommend blood tests such as CBC, ESR, blood urea nitrogen, blood culture, urine culture and urine analysis.
Pyonephrosis is a life threatening condition; therefore there should not be any delay in taking medical treatment by the patient. The main line of treatment is administration of intravenous antibiotics. Often surgery is required to drain the pus and accumulated urine in the affected kidney.
The pus can be drained in two different ways. A stent is placed in the ureter so that it becomes wide and allows drainage of pus through it. Ureter is a long tube attached to kidney and bladder. Normally urine formed in kidney passes through this tube into the bladder. The other way is percutaneous drainage of the pus.
Sometimes it may be necessary to remove the kidney if it has become non functional later on.