Renal cortex purulent infection
Introduction
Introduction to renal cortical purulent infection Renal cortical suppurative infection is a serious infection caused by staphylococcal blood transport into the renal cortex. In the absence of liquefied renal inflammatory mass called acute focal bacterial nephritis, the formation of abscess is called renal cortical abscess or suppurative Nephritis, a combination of several abscesses is called renal pelvis. In the development of broad-spectrum antibiotics, the incidence of renal cortical suppurative infection is reduced compared with the previous one due to the timely application of antibiotics to control the primary infection, and most of them are acute focal. Bacterial nephritis. basic knowledge Sickness ratio: 0.1% Susceptible people: no special people Mode of infection: non-infectious Complications: sepsis, renal cortical abscess
Cause
Causes of renal cortical purulent infection
Causes:
The most common pathogen is Staphylococcus aureus. The bacteria can be caused by purulent lesions in other parts of the body, and enter the kidney through blood circulation, such as sputum, sputum, abscess, infected wound, upper respiratory tract infection or adjacent renal tissue infection. Secondary to urinary tract obstruction such as urinary calculi or congenital malformations such as vesicoureteral reflux in children.
Pathogenesis:
Early lesions are confined to the renal cortex, forming multiple microscopic abscesses. These tiny abscesses can be assembled into multiple atrial abscesses. If not treated in time, renal pelvis can form, a small number can penetrate the renal capsule, invade the perirenal fat, and form the kidney circumference. Lump.
Prevention
Renal cortical purulent infection prevention
1. Strengthen exercise, enhance physical fitness, increase resistance, especially in winter, it is especially important to increase respiratory resistance.
2. Pay attention to strengthen personal hygiene and reduce the chance of streptococcal infection.
3. If pharyngitis, tonsillitis, cold, scarlet fever and other streptococcal infections have occurred, thorough treatment is also an important part of preventing acute nephritis.
4. Adjust your life, work and rest.
5. Some people with poor resistance are susceptible to upper respiratory tract infection in winter and can take preventive and detoxifying Chinese medicine.
Complication
Complications of renal cortical suppurative infection Complications sepsis renal cortical abscess
The treatment of this disease is not timely, can develop into sepsis, renal cortical abscess can penetrate the renal capsule into the kidney around the kidney caused by abscess.
Symptom
Symptoms of renal cortical purulent infection Common symptoms High fever, chills, loss of appetite, urgency, fatigue, frequent urination
Often there are other parts of the history of bacterial infection, sudden chills, high fever, low back pain, lack of appetite, lack of urinary frequency, urgency and other bladder irritation symptoms; late stage of bladder irritation due to infection invading the renal pelvis, affected side of the waist Muscle tension, kidney area and ridge ribs have obvious slap pain.
Examine
Examination of renal cortical suppurative infection
The total number of white blood cells and neutrophils in the blood is elevated, blood culture can be positive, and there is no white blood cells in the early urine. When the infection spreads to the renal pelvis, white blood cells can be found in the urine. The results of urine culture should be the same as blood culture. Pathogenic bacteria can be found in the puncture and pus culture.
Imaging studies vary according to the extent of the lesion.
1. Acute focal bacterial nephritis abdominal plain film often no obvious abnormality, intravenous urography is helpful for diagnosis, a small number of patients may have renal pelvis and renal pelvis compression, B-ultrasound shows renal parenchymal hypoechoic area, The boundary is unclear, CT examination is a low-density solid mass, and the density density is enhanced after enhancement. It is still lower than normal kidney tissue, and the boundary of the tumor is unclear. It is different from the clear wall of renal cortical abscess formed by neovascularization. CT shows renal parenchymal enlargement and multiple layers of renal fascia thickening is the qualitative diagnosis of the disease.
2. Renal cortical abscess Abdominal plain film shows enlarged kidney on the affected side, edema around the kidney makes the kidney shadow blurred, and the shadow of the psoas muscle is unclear or disappears. When the abscess ruptures around the kidney, lumbar scoliosis and venography can be displayed. Renal and renal pelvis compression deformation, B-mode ultrasound: showing irregular abscess contour, abscess is hypoechoic area, or mixed echo area, renal sinus echo deviation, slightly protruding to the renal edge, CT kidney scan shows renal cortical irregularity Low-density lesions, CT values between cysts and tumors, enhanced CT scan edge enhancement, no enhancement at the center, renal capsule, perirenal fascia thickening, disappearance with adjacent tissue interface, radionuclide kidney scan: showing kidney Occupational lesions, renal defect areas and renal cysts, with 67Ga can prompt infection of tissues.
Diagnosis
Diagnosis and diagnosis of renal cortical purulent infection
In addition to the above medical history, clinical signs and symptoms, combined with laboratory examination and imaging examination to determine the diagnosis.
Differential diagnosis
1. Peri-renal inflammation and peri-renal abscess mainly manifest as chills, fever, and low back pain, but the patient has lumbar vertebrae bent to the affected side, limb activity is limited, and KUB plain film shows increased density of the kidney area, and the shadow of the psoas muscle disappears, B Ultra and CT can identify whether it is a renal cortex or a purulent infection around the kidney.
2. Acute pyelonephritis mainly manifests as sudden chills, high fever, often accompanied by urinary frequency, urgency, dysuria and other bladder irritation symptoms, but also low back pain and sputum pain in the kidney area, but the urinary tract irritation is more serious. In the kidney area, the pain in the kidney area is lighter. B-ultrasound examination of the kidney has no liquid dark area. The venous urinary tract angiography (IVU) has no change in the displacement of the renal pelvis and compression, and CT has no mass.
3. The main manifestations of renal tuberculosis are urinary frequency, urgency, dysuria and other bladder irritation symptoms, accompanied by low-heat, night sweats, fatigue, anemia and other symptoms of systemic tuberculosis and different degrees of pyuria, but kidney tuberculosis patients have no high fever, and The frequency of urinary tract is more serious. Acid-fast bacilli can be found in 24 hours of urine. The early renal tuberculosis IVU shows that the edge of the renal pelvis is not neat, such as worm-like, and there is a sign of lack of one or several renal pelvis in the later stage. The urine is turbid with rice soup, accompanied by low fever, and B-ultrasound has effusion in the kidney.
4. Renal cysts Simple renal cysts are mainly characterized by low back pain, which may be accompanied by symptoms of hypertension, usually without fever. B-ultrasound examination shows that the renal parenchyma has a round liquid dark area with clear edges; the renal cyst puncture is grassy and transparent. liquid.
5. Renal tumors mainly include low back pain and lumbar and abdominal masses. CT and B-ultrasound examinations show that there is space-occupying lesions in the renal parenchyma. Renal tumors may have intermittent painless hematuria. IVU shows renal pelvis and renal pelvis deformation, destruction or disappearance. CT scan contrast agent showed an increase in renal tumors.
6. Acute cholecystitis mainly manifests as persistent pain in the right upper abdomen, which may be accompanied by chills, fever, abdominal muscle tension, positive Murphy sign, but normal urine, no white blood cells, B-ultrasound can be seen in the gallbladder wall rough, gallbladder increase Big.
7. The main manifestation of pleurisy is pain in the lower back. The pain is often aggravated by deep breathing and coughing. It is often accompanied by chills and fever. Physical examination can reduce the respiratory movement of the affected side and reduce the breath sound, but there is no obvious pain in the kidney area.
