7. Kidney Infection

Tawakal Shah E/Surgery/Prof.G.M.Shaikh/After Correction / Kidney Infection

1


2

KIDNEY INFECTION I. Acute pyelonephritis

(a) In child hood(b) In pregnancy(c) With urinary obstruction

II. Chronic pyelonephritis- Reflux nephropathy

III. PyonephrosisIV. Renal abcess (Renal carbuncle)V. Perinephric abcessVI. Renal tuber culosis


3

Aetiology of kidney infections1. Haematogenous

2. Ascending infection

Bacteriology

I. E Coli and other grame negative organisms

II. Streptococci faecalis

III. Proteus species

IV. Staphylococci


4

Acute Pyelonephritis - More common in females, common in

child hood, at puberty, soon after marriage, during pregnancy during menopause

- More common on right side- Frequently Bilateral


5

C.F

Headache, lassitude, nausea, sudden onset, rigor, vomiting. Acute pain in flank and hypochondrium. Pain may resemble renal colic rise of temperature to 38.8 or 3950C remitted followed by cystitis with urgency, frequency, scalding dysurea. Tenderness in hypochondrium and in the loin, damage to renal parenchyma, if bilateral may lead to uraemia.


6

Investigations

Urine DR. and urine for C/SC.F in severe cases

- Repeated rigors and temperature rises to 400C or more, with out corresponding rise in pulse rate

- Vomiting, sweating, thirst, patient, feels awful.

- Blood culture is usually positive especially taken during rigors.


7

D/D1. Pneumomia

2. Acute appendicitis

3. Acute cholicystitis

Investigations

• Plain abdominal film

• Skilled ultrasonography


8

Pyclonephritis of Pregnancy ??

Urine infection in child hood?

Acute pyelonephritis associated with urinary

retention?

Treatment of acute pyelonephnitis- Should be prompt: appropriate, prolonged.- Full investigations as soon as attack is controlled - Bed rest - Antibiotics broad spectrum type till c/s reports are

available- Plenty of fluids orally or parentarly- Alkanisation of urine if it is acidic- Analgesics - Treat underlying cause if any


9

Chronic pyelonephritis (Reflux Nephropathy) Pathology?

C.F Three times common in females Two third female affected are under 40 years. 60% males are over 40 years May remain silent till renal insufficiency apears Lumber pain Increased urinary frequency Dysurea Hypertension Constitutional symptoms Pyrexia Anaemia


10

InvestigationsUrine examination- Proteinurea<3g daily- Pus cells plenty- Bacteurea (Ecoli, S. faecalis, proteus, pseudomonas.

Treatment- It is difficult- Treat pre-disposing contributing factors- Antibiotics - Surgical treatment when only one kidney is affected which is unusual

(a) Nephrectomy(b) Bilateral cases with end stage renal failure

Renal transplantation


11

Pyonephrosis

G.F- Kidney is converted into a multi locular sac

containing pus or purulent urine

- Infected hydronephrosis

- Complications of renal calculus disease

- Usually it is unilaternal


12

C.F- Anaemia- Fever- Swelling in loin- May have symptoms of severe cystitis

Investigations

1. Plain X-ray

2. Ultrasonograpy

3. I.V.U

4. Urine DR


13

Treatment of Pyonephrosis

- Should be treated as surgical emergency

- Parenteral antibiotics

- Kidney drainage by aspiration or nephrostomy

- Pyelithotomy if there is stone

- Nephrectomy if non functing kidney and other kidney is normal


14

Renal caorbuncle (Intra renal abscess)Causes and Pre-disposing factors

- Blood born

- Traumatic haematoma

- Common in diabetics, i/v drug abusers, debilitating chronic disease, acquired immuno deficiency disease


15

Pathology

Renal parenchyma contains encapsulated

necrotic mass.

C.F- Tender swelling loin- Persistent pynexia- Lleucocytosis- No signs of infection in urine but apper after few days


16

D/D1. Perinephic abcess2. Renal adenocarcinoma

Investigation 1. Blood complete picture2. Urine examination and C/S3. I.V.U4. Ultrasonograpy5. C.T

Management


17

Perinephric abscessSources and causes

1. Haematogenous 2. Extension of cortical abscess3. Extension of appendix abscess on right side 4. Via periuretral lymphatics5. Infected peri renal haematoma, and

perinephric discharge of pyonephrosis and renal caorbuncle

6. Extension from T.B spine (Mycobacteria)


18

C.F- High swinging pyrexia- Abdominal tenderness- Fullness in loin- Polymorypho leucocytosis- No pus cells in urine

Investigation

Management


19

Treatment1. Antibiotics2. Surgery Aspiration or IxD

Investigations (Imaging)1. X-ray k.u.B

- Loss of psoas shadow - Reactionary scoliosis with concavity

towards same side- Elevation and immobility of diaphrgme on

affected side- Calculus may be present


20

2. Ultrasonography

3. C T Scanning

Treatment1. Antibiotics

2. Surgery

(a) Aspiration

(b) IxD and pus for C/S


21

Summaries


22

Clinical features of kidney infections

More common in women Often associated with septicaemia leading to

pyrexia and rigors Associated with pyuria and occasionally

haematuria Should be treated initially with broad- spectrum

parenteral antibiotics Extremely dangerous if the kidney is obstructed

Table: 75.19


23

Urinary infection in childhood A single proven urinary infetion in a

child should prompt referral to a paediatric urologist

Table: 75.20


24

Chronic pyelonephritis

A common cause of end-stage renal failure Often associated with ureteric reflux May be symtomatically silent Leads to progressive renal scarring

Table: 75.21


25

Box: 75. 22

Management of perinephric abscess Collections of pus in or around the

kidney should be drained Surgically if they cannot be aspirated by percutaneous needling.


26

Date post:	15-Oct-2014
Category:	Documents
Upload:	asadullah-jatoi
View:	36 times
Download:	2 times

7. Kidney Infection

Documents