perinephritis
Introduction
Introduction to perirenal inflammation Perinephritis refers to inflammation in the adipose tissue that occurs between the renal capsule and the perirenal fascia. If the infection forms an abscess, it is called a peri-renal abscess. Pathogenic bacteria are more common with Staphylococcus aureus and Escherichia coli, mostly by renal pelvis, renal surface abscess rupture and invading the surrounding tissues of the kidney, and a small number can also be directly transmitted to the surrounding tissues of the kidney by blood through distant inflammation. basic knowledge The proportion of illness: 0.004%-0.008%, mostly caused by pyelonephritis Susceptible people: no special people Mode of infection: non-infectious Complications: hydronephrosis
Cause
Causes of periarteritis
(1) Causes of the disease
Peri-renal inflammation, peri-renal abscess can be caused by a variety of pathogenic bacteria. In recent years, due to the widespread use of broad-spectrum antibiotics, blood-borne infections have been decreasing, and pathogenic bacteria have been mainly Staphylococcus aureus, converted to Escherichia coli and transformed. Bacillus is the main strain, followed by Staphylococcus aureus, and other pathogens include many Gram-negative bacilli, such as Klebsiella, Enterobacter, Pseudomonas and Pseudomonas aeruginosa, Enterococcus and Streptococcus It has also been reported in the literature that certain anaerobic bacteria such as Clostridium, Bacillus licheniformis and actinomycetes can also cause disease, and conventional bacterial cultures are negative, and about 25% of perirenal abscesses are mixed infections.
(two) pathogenesis
Infection pathways include: 1 intrarenal infection spread to the perirenal space, most perirenal abscess infection by this route, including renal cortical abscess, chronic or recurrent pyelonephritis (due to the presence of urinary tract obstruction), renal empyema, yellow granulomatous Pyelonephritis, etc., 2 blood-borne infections, infections in other parts of the body, infiltration into the peri-renal space by blood, common skin infections, upper respiratory tract infections, etc. 3 invasive retroperitoneal lymphatic system, from the bladder, seminal vesicles, prostate, rectum Surroundings, infections of the fallopian tubes or other pelvic tissues, from the lymphatic vessels to the periphery of the kidneys, 4 infections from adjacent renal tissues, including the liver, gallbladder, pancreas, high appendicitis of the cecum and adjacent ribs or vertebral osteomyelitis, sometimes kidney trauma And infections caused by kidney and adrenal surgery.
Peri-renal inflammation can be treated in time, inflammation can disappear, fibrosis, such as continued development, the formation of abscess, depending on its location can cause pleural effusion of the affected side, pneumonia at the bottom of the lung, bronchopleural fistula, underarm abscess and axillary abscess.
Prevention
Peripheral inflammation prevention
Early detection and early diagnosis are the key to the prevention and treatment of this disease.
1. Rest in bed, relieve heat and relieve pain, and maintain water and electrolyte balance.
2. Apply a broad spectrum of effective antibiotics.
3, B-ultrasound or puncture after the pus should be cut open early.
Complication
Peripheral inflammation complications Complications hydronephrosis
If the peri-renal abscess is delayed, it will go up through the diaphragm and enter the thoracic cavity to form bronchospasm. The abscess extends down to the sputum or groin. Occasionally, the abscess crosses the spine and invades the contralateral renal space. Abscess compression of the ureter can cause hydronephrosis. After the abscess is drained, the ureteral stenosis may be caused by the growth of fibrous tissue during the healing process.
Symptom
Symptoms of inflammation around the kidney Common symptoms Kidney abscess, severe pain, abscess, upper abdominal pain, chill, subcutaneous tissue edema
Such as secondary to severe chronic kidney infection, there is a history of persistent and recurrent urinary tract infections, such as Staphylococcus aureus infection, often infected with other parts of the body (such as skin infections), inflammation around the kidney is slow, the affected side There is pain in the kidney area. When the abscess around the kidney begins to form 2 weeks later, the patient has symptoms such as chills, fever, pain in the affected side of the lower back and upper abdomen, pain in the ribs, lumbar muscle tension and skin edema, and can reach the mass. When the affected limb flexes and extends and the trunk bends to the healthy side, it can cause severe pain.
Examine
Examination of periarteritis
1, urine routine examination of urinary leukocytosis, pyuria;
2, urine sediment smear staining to find bacteria;
3, urinary bacteria culture to find bacteria;
4, urine colony count > 10 5th power / ml, there are symptoms of urinary frequency and other symptoms > 10 2 square / ml is also meaningful; cocci 10 10th power -10 4 power / ml also have diagnostic significance;
5, one hour urine sediment count white blood cells>20;
6, blood routine shows that white blood cells increase neutrophil nucleus left shift;
7, ESR increased
8, X-ray examination of the abdominal plain film shows that the spine bends to the affected side, the psoas muscle and kidney shadow are blurred. Chest penetration can be seen in the affected side of the diaphragmatic muscle elevation, limited activity. Excretory urography shows a poor range of renal development or a reduced range of movement, even without breathing.
9, B-ultrasound can show a low echogenic mass in the kidney, with irregular walls sometimes multi-atrial, under the guidance of B-ultrasound to the perirenal fat sac puncture, pump out pus to confirm the diagnosis.
10, CT is the most valuable, can show the soft tissue block of the kidney, the central CT value of 0 ~ 20Hu, with an inflammatory wall layer, enhanced rear wall layer is strengthened adjacent tissue level is unclear. Thickening of the perirenal fascia A gas or gas-liquid plane is visible in the abscess.
Diagnosis
Diagnosis and differentiation of periarteritis
Peri-renal inflammation and perirenal abscess should be combined with laboratory examination and imaging examination in addition to medical history and physical signs to confirm the diagnosis.
Differential diagnosis
1. Renal cortical purulent infection also manifests as fever, low back pain, obvious muscle tension and tenderness in the affected side of the waist, but the body temperature is higher, and local symptoms are not obvious with periarteritis and peri-renal abscess. X-ray examination, KUB plain film Renal cortical suppurative infection showed unclear kidney shadow, but visible lumbar muscle shadow, and no scoliosis, B-ultrasound and CT examination can distinguish between intra-renal or peri-infection.
2. Acute pyelonephritis is mainly characterized by fever, frequent urination, urgency, dysuria, physical examination, and sputum pain in the kidney area, but the urinary tract irritation is obvious, and there is no limitation of limb activity. Urine routine examination has white blood cells. B-ultrasound and CT examination can distinguish whether it is a peri-renal infection.
3. Kidney papillary necrosis mainly manifests as sudden onset of fever, low back pain, hematuria, can rapidly develop into septic shock, usually have a history of diabetes or a history of taking painkillers, but no affected side of lower limb activity, B-ultrasound and CT examination It can be distinguished from intra-renal or peri-infection.
4. Perirenal cysts mainly manifest as low back pain, lumbar and abdominal masses, etc., but low back pain is mostly persistent dull pain, and there is no sputum pain in the kidney area and lumbar muscle stimulation. B-ultrasound has a low echo area around the kidney. Evenly, the puncture can extract a yellow transparent liquid.
