Hydropyonephrosis: Description, Causes and Risk Factors:
Presence of purulent urine in the pelvis and calices of the kidney following obstruction of the ureter.
The kidneys are located in the retroperitoneum and measure approximately 12 cm (height), 6 cm (width) and 4-5 cm (depth). The kidneys are essential for life. Their major function is to regulate the water content, mineral composition and acidity of the body. They are also involved in the excretion of metabolic waste products and of various chemicals. The kidneys also produce hormones which are involved in the production of blood cells, in the absorption of calcium from food, and in the control of blood pressure.
Hydropyonephrosis main cause is upper urinary tract infection in combination with obstruction. This may progress to renal and perirenal abscesses. Risk factors for hydropyonephrosis include immunosuppressiondue to medications (eg, steroids), disease (eg, diabetes mellitus,AIDS), and any anatomic urinary tract obstruction (eg, stones, tumors, UPJ obstruction, pelvic kidney,horseshoe kidney). Immunocompromisedpatients and those who are treated with long-term antibiotics are at an increased risk for fungal infections. Whenfungus balls are present, they may obstruct the renal pelvis or the ureter, resulting in hydronephrosis. Xanthogranulomatous pyelonephritis, a clinical condition consisting of upper renal calculus and infection, has been reported to progress to hydronephrosis when obstruction is present.
Hydropyonephrosis is relatively uncommon, and the true incidence of development with other renal infections is not reported. However, the risk of hydropyonephrosis is increased in patients with upper urinary tract obstructionsecondary to various causes (eg,stones,tumors,ureteropelvic junction [UPJ] obstruction.
Hydronephrosis is obstruction to the free flow of urine, which is produced by the kidney. Once there is obstruction there is potential for infection, as the urine is stagnant. Common causes of obstruction are stones, strictures, tumor etc.
There are several common organisms like E. coli, Proteus, Psuedomonas, Staphylococcus etc, which cause this bacterial infection. Many a time it is a combination of organisms, which cause the infection.
Certain other diseases like Diabetes, Anemia, medication of steroids for other diseases may aggravate the infection and cause rapid progression.
Pain in the flanks.
- High grade fever which may be intermittent.
- Severe chills and rigors.
- Vomiting and giddiness.
- Feeling exhausted, weak and really sick.
- Pus in the urine.
- Swelling in the flanks.
- Feeling of uneasiness in the stomach.
Urinalysis may show signs of urinary tract infection. Specifically, the presence of nitrite and white blood cells on a urine test strip in patients with typical symptoms are sufficient for the diagnosis of hydropyonephrosis, and are an indication for empirical treatment. Blood tests such as a complete blood count may show neutrophilia. Microbiological culture of the urine, with or without blood cultures and antibiotic sensitivity testing are useful for establishing a formal diagnosis.
This is a serious emergency and needs hospitalization, intensive monitoring, antibiotics and expert supervision. If not promptly treated it can be fatal.
Hydropyonephrosis is a surgical emergency and needs immediate intervention. Hydropyonephrosis may be treated with either an antegrade or a retrograde decompression. Retrograde decompression, or placement of a ureteral stent is indicated in stable patients with no signs of hemodynamic instability. Intravenous antibiotics must be given prior to stent placement in stable patients; after this is done, retrograde decompression may be safely undertaken. Disadvantages of retrograde decompression include lack of antegrade access for radiologic studies, smaller-caliber urinary drainage catheter than with percutaneous access, increased irritative urinary symptoms, inability to administer medications such as antibiotics via nephrostomy tube, and limitation of percutaneous chemolysis that may cause dissolution of any stones. To maximize drainage, a urethral catheter should be left in place after stent placement.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.