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[Pyonephrosis: diagnosis and treatment: report of 14 cases]
Abstract:
Prior to the introduction of antibiotics, the treatment of pyelonephrosis frequently consisted of nephrectomy to remove the non-functional kidney, which was a potentially dangerous source of systemic infection. This approach was later modified as a result of the advances made in antibiotic therapy, and included vigorous antibiotic treatment and prompt drainage of the kidney. At present, percutaneous nephrostomy provides a means of draining off the pus and determining a possible residual renal function. In this study, 14 cases of pyonephrosis were observed over a 7-month period. Lumbar pain was noted in 70% of cases, painful lumbar contact in 5 cases and fever, shivering and pyuria in all cases. Cytobacteriological urine analysis showed the presence of Escherichia coli in 7 patients, Proteus in 4 patients, and in 3 cases abacterial leucocyturia; in 2 patients with only one functional kidney, renal insufficiency was observed. In all cases, the diagnosis was confirmed by ultrasonography. The main etiological factors were urinary lithiasis in 10 patients (71%), followed by uropathy of the pyeloureteral junction in 4 patients (29%). Treatment consisted of primary nephrectomy in 10 cases; in 3 cases, primary nephrostomy was performed with a positive outcome and recovery of renal function in 2 subjects; in one case of renal failure treated by nephrostomy followed by conservative surgery, the patient did not survive. In conclusion, nephrectomy is advocated as the treatment of choice in the case of a damaged kidney and a normal contralateral kidney. Conservative treatment should be envisaged particularly in the case of a single kidney, or if the patient's state of health is poor. The best treatment consists of the detection and cure of the lithiasis which is the main etiological factor in this pathology.
Insights
Pyonephrosis treatment has evolved from nephrectomy to include antibiotics and drainage. Nephrectomy remains preferred for a damaged kidney with a healthy contralateral kidney, while conservative approaches suit single kidneys or poor health.
Area of Science:
- Urology
- Infectious Diseases
- Nephrology
Context:
- Historically, pyonephrosis management often involved nephrectomy due to infection risks.
- Advances in antibiotics and percutaneous nephrostomy have shifted treatment paradigms.
- Pyonephrosis presents with symptoms like lumbar pain, fever, and pyuria, often linked to urinary lithiasis.
Purpose:
- To analyze the diagnostic and therapeutic approaches for pyonephrosis.
- To evaluate treatment outcomes based on kidney status and patient health.
- To identify the primary etiological factors contributing to pyonephrosis.
Summary:
- This study reviewed 14 pyonephrosis cases, noting Escherichia coli and Proteus as common pathogens.
- Ultrasonography confirmed diagnoses, with urinary lithiasis being the predominant cause (71%).
- Treatment varied: nephrectomy (10 cases), nephrostomy (3 cases with 2 recoveries), and one fatal case with renal failure.
Impact:
- Nephrectomy is recommended for damaged kidneys with a healthy contralateral kidney.
- Conservative management, including nephrostomy, is crucial for single kidneys or compromised patients.
- Addressing underlying lithiasis is key to preventing and treating pyonephrosis effectively.