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EARLY DIAGNOSIS OF PURULENT FORMS OF ACUTE
PYELONEPHRITIS
Qo’ziyev Sohib Saloyiddin o’g’li
Bukhara Innovative Education and Medical University.
Bukhara .Uzbekistan
assistant of the Department of clinical and pre-clinical sciences
Аnnotation.
This article provides an overview of one of the most relevant
topics in modern urology – the early diagnosis of purulent forms of
pyelonephritis. It presents the current state of the issue and highlights the key
debatable aspects of the problem. The article reviews nearly all non-invasive
imaging methods for diagnosing various forms of purulent pyelonephritis,
demonstrating their capabilities, advantages, and limitations.
Keywords:
Acute pyelonephritis, ultrasound examination, calyceal and renal
pelvic system, excretory urography.
Acute pyelonephritis (AP) is a bacterial inflammation of the renal
parenchyma and collecting system. According to N.A. Lopatkin, pyelonephritis is
a non-specific infectious-inflammatory disease of the kidneys, involving the renal
pelvis, calyces, and parenchyma, primarily affecting the interstitial tissue. In the
final stage of the disease, the process spreads to the blood vessels and
glomeruli.Pyelonephritis, which is based on pre-existing organic or functional
urinary dynamics disorders, is referred to as secondary. Primary pyelonephritis is
characterized by initial infection of the urinary tract. AP can be either diffuse or
focal. Purulent forms of AP include abscess, carbuncle, and apostematous
nephritis. Pararenal retroperitoneal abscess is a complication of pyelonephritis.
Local forms of bacterial inflammation often transform into abscesses, initially
small, which then merge to form carbuncles or large abscesses. Acute localized
pyelonephritis is a localized form of kidney infection, and in foreign literature,
this form is also referred to as acute lobar nephronia, analogous to acute lobar
pneumonia.[1]
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Some authors consider limited pyelonephritis to be an intermediate stage
between simple pyelonephritis and abscess. It is possible that acute bacterial
localized pyelonephritis (analogous to a furuncle) represents an early stage in the
formation of an abscess, where inflammation has not yet reached the stage of
alteration and purulence. In any case, it is often difficult to distinguish a focus of
non-specific inflammation from an abscess. However, there is a critical need to
differentiate localized serous AP from purulent forms of AP, as this determines the
choice of treatment strategy. Simple focal inflammation can be successfully
treated with antibiotics, whereas purulent pyelonephritis often requires surgical
intervention.[2]
In at least one-third of patients, acute pyelonephritis (AP) immediately
develops as a purulent process, such as apostematous pyelonephritis, carbuncle,
and abscess. Additionally, 64% of serous AP cases progress to purulent form. The
disease is accompanied by pronounced intoxication and often leads to septic
shock, with mortality rates ranging from 60% to 92%. The frequency of
nephrectomy due to the purulent process in the kidney is 25-50%, and
postoperative mortality reaches 18.9-28.7%.[3]
The diagnosis of acute pyelonephritis (AP) is based on a comprehensive
approach, including medical history, clinical presentation, laboratory tests,
endoscopic, and imaging methods. A review of extensive literature shows that
treatment outcomes for AP are significantly influenced by the early diagnosis of
its various forms and the extent of kidney parenchymal involvement. This is
particularly important for assessing the transition from serous to purulent
inflammation, which requires a different treatment approach.[4]
Conclusion.
Acute pyelonephritis (AP) is a bacterial infection affecting the
renal parenchyma and collecting system, primarily involving the interstitial tissue.
It can be primary, with initial urinary tract infection, or secondary, resulting from
pre-existing urinary dysfunction. AP can manifest in both diffuse and focal forms,
with purulent cases including abscesses, carbuncles, and apostematous nephritis.
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The disease can progress rapidly, with 64% of serous cases turning purulent,
leading to severe complications such as septic shock and high mortality rates.
Early diagnosis, including clinical and imaging methods, is crucial for
determining the extent of kidney involvement and guiding treatment decisions.
Differentiating between serous and purulent inflammation is key, as purulent
forms often require surgical intervention, while focal inflammation can typically
be treated with antibiotics.
REFERENCES
1. Карпенко В.С., Переверзев А.С. Лечение гнойного пиелонефрита //
Клин. хир. – 1976. – №9. – С.31–38.
2. Лопаткин Н.А. Урология. – М.: Медицина, 1992.
3. Власов П.В., Курбатов Д.Г. Лучевая диагностика острого
пиелонефрита // Радиол. - практика. – 2004. – №3. – С.62–68.
4. Быковский В.А. Ультразвуковая семиотика острого пиелонефрита //
Ультразвук. диагност. – 1998. – №6. – С.69–74
