Carbuncle of the kidney: dissection, treatment, causes, symptoms, prevention

August 12, 2017 15:31 | Carbuncle

Kidney carbuncle - a pathological inflammatory formation in the cortical tissue of the kidney in the form of an isolated purulent focus with the formation of a necrosis zone, consisting of multiple small suppuration.For reasons, development and symptomatology refers to one of the forms of bacterial pyelonephritis( inflammation of the kidneys).

About the symptoms, causes and treatment of the carbuncle of the right and left kidneys, medical history, we will tell you with useful photos in this material.

Features of the disease in humans

It is important to know what a carbuncle of this type looks like.Externally, the pathology resembles a subcutaneous carbuncle and looks like a round convex formation.In the section there is a non-viable tissue, saturated with small pustules, merged with each other.

In half the histories of pathology development, the renal carbuncle arises against the background of apostematous pyelonephritis( inflammation of the kidneys with the formation of a large number of small abs

cesses - the aposteme), therefore pathologies do not have significant differences in clinical manifestations.

Stages What does carbuncle look like

What does carbuncle look like

Two basic stages are distinguished in the formation of the renal carbuncle:

  1. In the substance of the kidney cortex, around the area where the blood flow is difficult due to the closure of blood vessels with a bacterial thrombus, inflammation progresses, surrounded by infiltration( dense edema,Limiting the pathological focus).At this stage, with competent therapy, the process can be slowed down and stopped.Without providing medical assistance, inflammation passes to the walls of arterioles passing through the inflammatory focus - they swell, which causes them to clog with a violation of blood flow.As a result, cells in the kidney that is now insufficiently supplied with oxygen( ischemia) die( infarction).
  2. In the next stage, staphylococci are introduced into the site of the infarction, causing the final disintegration of tissues with the formation of a zone of necrosis and suppuration.As a result, a purulent-necrotic isolated foci is formed - a carbuncle having a size from a lentil granule to a chicken egg.

The foci of suppuration may remain limited for a long time, as a result of which the tissue, which is not viable due to the stoppage of the blood supply, becomes impregnated with pus.The clinical picture in this case is similar to the signs of the development of a typical cutaneous carbuncle, which gave rise to the name of pathology carbuncle of the kidney.

Forms

Inflammation most often affects the right kidney.In most patients carbuncle develops on the one hand, but in 5% of cases, bilateral damage is observed.In 8 - 12% reveal the development of several pathologies.

The disease occurs in the following forms:

  • typical acute,
  • erased and atypical.

Reasons for the occurrence of

The causes of the origin of the kidney carbuncle are usually the following:

  1. Penetration of staphylococcal microflora into the renal tissue from the removed purulent inflammatory foci, which the patient forgets about the time of the appearance of the renal carbuncle.The emergence of pathology is preceded by such diseases as furunculosis, subcutaneous carbuncle, osteomyelitis, panaritium, pneumonia, phlegmonous tonsillitis, mastitis.Pathogenic microorganisms, moving with blood, form a thrombus( clot) from pyogenic microorganisms, overlapping the lumen of a large renal vessel or several small ones passing "in the neighborhood".If a massive vessel is blocked - a large area of ​​nonviable tissue is formed due to the stoppage of blood supply to cells, small, rapidly fusing necrosis foci appear when small vessels are blocked.
  2. Active progression of acute pyelonephritis.
  3. Obstruction of urine outflow due to stone ureter blockage, bladder cancer, ovaries, uterus, prostate tumor, narrowing of the urinary canal, pregnancy.

The way of penetration of pathogenic microorganisms into the cortex of the kidney is in some cases difficult to establish, but the typical pathways are as follows:

  • lymphatic and blood vessels;
  • the wall and lumen of the ureter when the liquid is poured from the bladder.

The most common pathogens of the renal carbuncle are staphylococcus aureus( golden and white)( Staphylococcus aureus / albus), gram-negative bacteria - intestinal( Escherichia coli) and Pseudomonas aeruginosa( Pseudomonas aeruginosa), anaerobic proteins( Proteus).

Diseases conducive to development of abscess:

  • diabetes mellitus;
  • systemic lupus erythematosus;
  • myocardial ischemia;
  • cardiosclerosis, atherosclerosis;
  • chronic pancreatitis, cholecystitis;
  • inflammation of female reproductive organs.The symptoms of development in the kidney of the carbuncle are directly related to the degree of suppuration, the patency of the urinary tract, the exact location of the abscess, the stage of the disease, the functioning of the organ and the diseases accompanying the underlying pathology.

The abscess in the kidney progresses, under the cover of various "packets" of symptoms, such as:

  • symptoms, typical for any suppuration;
  • manifested in cardiovascular pathologies;
  • abdominal( acute manifestations in the peritoneum);
  • taking the form of neuropsychiatric disorders;
  • thromboembolic and pulmonary;
  • peculiar to pathological changes in the kidney and liver;
  • latent( erased).

The danger of any atypical symptomatology in the renal carbuncle is that it masks the true clinical picture, leading to a deliberately false diagnosis and loss of time for the decision to treat a real pathology - an abscess growing in the kidney. Often patients with atypical symptoms are hospitalized in pulmonology, cardiology, infectious diseases, and an accurate diagnosis is established after the patient has died.

Description Description of symptoms
Typical general and local( local) Manifestations of acute purulent inflammation with intoxication poisoning that emit pyogenic microbes:
severe general weakness;Abnormal fatigue, loss of appetite;Pallor of the skin and mucous membranes;Paroxysmal vomiting.
Specific symptoms of renal inflammation blunt, drawing back pain;Tremendous chills in the background of fever( up to 40 - 41C);Plentiful cold sweat, dripping with drops;Oliguria( pronounced decrease in the volume of urine);Lowering blood pressure.
Local( not always shown) muscle tension defenses with pressure on the peritoneum and waist;Pronounced soreness with a slight tapping of the lumbar region in the kidney( Pasternatsky's symptom);A noticeable increase and soreness of the organ during palpation.
Abdominal Manifestations simulating the totality of symptoms of the "acute abdomen":
sharp pains in the stomach and stomach( spilled and localized);Nausea and frequent vomiting;Gas retention, constipation;Tension of the peritoneum when attempting to palpate( feel);And also:
soreness and swelling of the lumbar tissues in the area of ​​the location of the kidney( late symptom);High level of leukocytes: 10 - 20x109 / l, but when a carbuncle occurs for the first time - in the early stage of the disease urine, as a rule, sterile;Piuria of the middle degree( the appearance of pus in the urine).
Gastrointestinal Signs that simulate the development of dysentery:
spastic and dull pain in the stomach and abdomen;Frequent stool with pain and irritation of the anus area, false desires;Nausea, vomiting;Presence of feces in feces.
Cardiovascular pathology clinic tachycardia or, conversely, bradycardia( decrease in the frequency of myocardial contractions);Decreased or increased blood pressure;Symptoms of an acute disorder of blood supply to the tissues of the heart muscle;Failure of right ventricular function;Disturbance in conduction of the myocardium;Swelling of the extremities.
Neuropsychomorphous symptomatology In patients with renal carbuncle, the actual clinical picture is "erased", and the signs of psychoneurological disorders dominate:
excessive activity, excitation;Insomnia, delirium, hallucinations are possible;Abnormal excitation of the subcortical layers of the brain accompanied by tonic( prolonged muscle spasm) and clonic( cyclic spasm) convulsions;Symptoms of dysfunction of the central nervous system trunks In this complex case, only an analysis of an experienced specialist in diagnosis allows us to establish the true origin of neurological signs caused by severe intoxication with suppuration in the kidney.
Hepatopathy and nephropathy There are cases when local signs of carbuncle are poorly expressed, the composition of urine is almost unchanged, and in the foreground there are symptoms of severe liver damage:
acutely developing jaundice with severe yellowing of the skin, mucous membranes, sclera;Blunt pulling pain in the right hypochondrium;An increase in the organ and soreness when feeling;Nausea with urge to vomit;Signs of acute violations of the liver and kidneys.Such symptoms are observed in elderly people, weakened, more often with the presence of multiple carbuncles in the kidney, and also with their localization in both kidneys.
Erased symptoms Observe absence:
pain and hyperthermia( fever);Changes in the pattern of blood or changes not characteristic of acute suppuration;Changes in the composition of urine.The general symptoms of undiagnosed disorders predominate in the functioning of the organism and in the preceding diseases.
Atypical symptomatology often causes an incorrect diagnosis and treatment tactics.
Pulmonary Sometimes there is thromboembolism of the vessels of the brain and lungs - clogging of the lumen of the vessel with a clot of pathogenic bacteria.With incorrect diagnosis, the patient dies, and the carbuncle of the kidney is detected only at the autopsy.

Diagnostics

  • To determine the development of carbuncle of the kidney during diagnosis is difficult, because the symptoms are too diverse.The initial diagnosis is usually presumptive, which is based on pain, acute onset of the disease and ultrasound of the kidney carbuncle.
  • Often a preliminary diagnosis is made based on signs that mask the true pathology and treated as manifestations of pancreatitis, appendicitis, cholecystitis, gastroenteritis, acute pyelonephritis, bronchopneumonia, urolithiasis.

Thus, treatment with an incorrect diagnosis is aimed at eliminating the existing symptoms, and the carbuncle remains unrecognized.

  • In the initial development of a single renal carbuncle, changes in the urine are often not observed, or these changes are typical for acute inflammation in the urinary system: increased amounts of protein, leukocytes, impurity of blood, the presence of bacteria.
  • Blood changes are also not specific and correspond to the signs of the inflammatory process - an increase in the number of leukocytes, high ESR, anemia.

The most valuable and objective research methods for the diagnosis of renal carbuncle:

  • radionuclide( isotope) kidney scan or scintigraphy;
  • X-ray and ultrasound of kidney and ureter;
  • excretory urography;
  • ultrasonography;
  • study of Doppler;
  • Magnetic Resonance Imaging( MRI).

The carbuncle of the kidney is differentiated with acute cholecystitis, pancreatitis, parenchyma tumors, festering kidney cyst, abscess, kidney tuberculosis.

Now let's find out how to treat kidney carbuncle.

Treatment of kidney carbuncle

Therapeutic and medicamentous way

Massive therapy of kidney carbuncle with antibiotics as an independent method is prescribed only in the initial stage with constant urological observation.But, as a rule, antibacterial treatment does not give positive results, as dense suppuration affects the vessels and interferes with the movement of blood in the kidney.Therefore, substances that kill microbes are unable to penetrate the carbuncle zone.

A technique for combining antibiotics and cryoprecipitate has been developed that promotes an increase in the concentration of fibronectin( a non-collagenic two-component protein compound) in the blood, which leads to the restoration of blood flow in the affected area, promoting the reverse development of renal inflammation.

In 85% of patients, as a result of this complex treatment, the blood flow of the zone with disturbed blood supply is restored, the signs of ischemia disappear, the means destroying the bacteria penetrate into the suppuration spot and the inflammatory process gradually subsides.

Surgical treatment

In most cases, after detection of a renal carbuncle, almost all patients undergo emergency surgical treatment.

  1. The first stage is lumbotherapy, that is, the opening of the retroperitoneal space, the release of the kidney from the capsule and its examination.
  2. Further, the tactics of surgical treatment determine:
    • the patient's condition;
    • character of pathological changes;
    • type of carbuncle;
    • the quality of the functioning of the second kidney.

In almost 95% of cases, patients undergo autopsy of the carbuncle, in which the abscess is dissected crosswise to the depth of the viable healthy tissue.Then, tubular drainage is installed in order to completely drain the pus.Simultaneously restore the broken passage of urine.

If purulent tissue melting has destroyed a large area of ​​the kidney, or multiple carbuncles are detected in the kidney, the kidney is removed( nephrectomy).This tactic of treatment is radical and is more often used in elderly people.But as a result, health, and often - the life of the patient is preserved, and with the active maintenance of the functioning of the second kidney, the quality of life is approaching the favorable one.

If the surgical treatment is carried out in a timely manner and with preservation of the kidney, the recovery period usually passes without complications.

Notes:

  • gradual temperature drop to normal;
  • stagnation of pain and symptoms of intoxication;
  • rapid recovery of kidney function.

In the recovery phase,

  • antibiotics are prescribed, which are selected depending on the sensitivity of the detected pathogenic microorganisms to them.
  • means and procedures for eliminating the symptoms of poisoning and removing residual poisons;
  • laser treatment, which removes puffiness and improves blood microcirculation in the operated area.

Next, the prevention of kidney carbuncle disease is considered.

The video below shows the operation of a kidney carbuncle:

Prevention

Primary development of carbuncle in the kidney can be prevented if the causes of its appearance and factors causing obstruction of the urinary tract are eliminated.For this, timely and adequate treatment of existing pathologies, which are capable of provoking the appearance of abscesses in the kidneys, is necessary.These are urological pathologies, and any purulent processes that are clearly or secretly flowing in different organs and tissues.

Complications

Carbuncle kidney photo With late or incorrect diagnosis, inadequate treatment tactics, the development of the kidney carbuncle leads:

  • to pleurisy, pneumonia, pulmonary insufficiency;
  • toxic damage and pulmonary edema;
  • to the transition of suppuration to the renal pelvis, cellulose and the development of purulent paranephritis( inflammation of the cellulose surrounding the kidney with the formation of an abscess).

Sometimes in patients in the rehabilitation period, after surgical excision of the carbuncle, severe purulent intoxication develops.To eliminate it, treatment is complemented by detoxification therapy, including:

  • hemodialysis and plasmapheresis( blood purification, performed extracorporeally, that is - outside the body);
  • hemo- lympho- and plasmasorption( excretion of toxins from blood, plasma and lymphatic fluid);
  • exchange blood transfusion.

Forecast

In patients with a single carbuncle and normal urine outflow with a timely surgical operation, the prognosis is quite favorable.In other cases, especially with atypical symptoms, timely diagnosis and immediately started surgical treatment are of particular importance.