Kidney abscess
Introduction
Introduction Renal abscess refers to the destruction of the renal parenchyma due to inflammation and suppuration, the formation of a purulent cyst, complete loss of renal function, urinary tract regurgitation and other urinary tract abnormalities can cause renal cortical medullary abscess. Renal cortical abscesses are usually caused by Staphylococcus aureus. In contrast, renal cortical medullary abscess is often caused by infection with Escherichia coli, Klebsiella or Proteus, and is common in patients with upper urinary tract obstruction. Clinical symptoms of renal abscess: high fever, chills, general malaise, vomiting, collapse, patients with varying degrees of anemia.
Cause
Cause
The pathogenic bacteria are mainly Escherichia coli and other Enterobacteriaceae and Gram-positive bacteria, such as E. coli, Proteus, Streptococcus faecalis, Staphylococcus, Alcaligenes, Pseudomonas aeruginosa and the like. Very few are pathogenic bacteria such as fungi, viruses, and protozoa. Most of the urethra enters the bladder, and the ascending infection passes through the ureter to reach the kidney, or is spread by the blood to the kidney. The incidence of women is several times higher than that of men. Women are more likely to develop during childhood, new marriage, pregnancy and old age. Urinary tract obstruction, vesicoureteral reflux and urinary retention can cause secondary pyelonephritis.
Examine
an examination
Related inspection
Renal angiography retroperitoneal angiography
There are typical clinical manifestations. Urine tests include white blood cells, red blood cells, proteins, casts and bacteria. Urine bacteria culture has more than 100,000 colonies per milliliter of urine, and blood white blood cell counts increase. Neutrophil enlargement is obvious, and it is not difficult to determine the diagnosis. Clinically, acute pyelonephritis is often accompanied by cystitis, and lower urinary tract infection can cause ascending infection involving the kidney, sometimes difficult to distinguish. However, the lower urinary tract infection is characterized by bladder irritation as the main clinical manifestation, and often has lower abdominal discomfort, soreness, and few systemic symptoms such as chills and fever. After the acute phase symptoms control, the patient should be further examined to find out whether there are anatomical abnormalities such as urinary tract obstruction and vesicoureteral reflux for further treatment.
Diagnostic points: 1. fever, low back pain, kidney block. 2. A large number of pus cells in the urine. 3. The white blood cells in the blood are significantly increased. 4. X-ray plain film is enlarged, and the kidney is not developed after angiography.
Diagnosis
Differential diagnosis
It needs to be distinguished from the following symptoms:
Immune nephritis: A chronic glomerular disease of the kidney that is caused by various causes. Also known as primary immunoneuritis is distinguished from secondary. Clinically, secondary chronic kidney damage caused by systemic diseases such as diabetes, systemic lupus erythematosus, gout, etc., is named according to its primary disease, such as diabetic nephropathy and lupus nephritis. Because the diagnosis and treatment of these cases are mainly based on systemic diseases (such as diabetes), it is very different from the primary. The incidence of immunological nephritis in China is still very high. The incidence rate in China in 1981 was 0.28-0.89%, which was one of the most important causes of chronic renal failure (60%). The immunological nephritis caused by different causes is similar in symptoms and has similarities in treatment, but the prognosis varies from light to heavy. The disease is mainly caused by an immune reaction caused by kidney damage. Different causes can have the same kidney damage. Clinical manifestations of varying degrees of proteinuria, hematuria, tubular urine, edema, hypertension and varying degrees of renal dysfunction. The onset can be urgent, but most cases do not evolve from acute nephritis. Therefore, the understanding of immune nephritis should be the continuous or progressive development of potential pathological changes, so that the disease is prolonged and becomes chronic, not simply the chronic stage of acute nephritis. Modern medicine can understand the pathological changes of kidney tissue through renal biopsy to determine the prognosis and guide treatment.
Kidney damage: Kidney damage is common in liver-derived kidney damage. Hepatic-induced renal damage is also known as hepatorenal syndrome. Hepatic-induced renal damage mainly includes: 1 glomerulonephritis caused by hepatitis B virus; 2 glomerulonephritis mainly caused by IgA nephropathy caused by disorders of immunity, physiology and metabolism in liver cirrhosis; 3 severe liver In the case of insufficiency, functional acute renal failure caused by hypoperfusion of the kidney, namely hepatorenal syndrome.
Hydronephrosis in the kidney: hydronephrosis is caused by obstruction of the urinary tract and enlargement of the renal pelvis and renal atrophy. Urinary tract obstruction can occur anywhere in the urinary tract, either unilaterally or bilaterally. The degree of obstruction can be complete or incomplete, and can cause hydronephrosis after a certain period of time. Stenosis or obstruction of any part of the urinary tract and normal function of the neuromuscular can cause obstacles in the passage of urine, causing obstruction of the urine flow. The upper part of the obstruction is gradually increased due to poor urine discharge, and the lumen is enlarged, eventually leading to Kidney water, expansion, thinning of the renal parenchyma, renal dysfunction, if bilateral obstruction, the consequences of uremia are serious.
