View source for Pyonephrosis

{{short description|Infection and accumulation of pus within the kidney}}
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| name          = Pyonephrosis
| image         = Kidney showing a condition of acute pyonephrosis Wellcome L0061752.jpg
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'''Pyonephrosis''' ({{ety|el|pyon|pus||nephros|kidney}}<ref>{{DorlandsDict|seven/000088935|pyonephrosis}}</ref>) is a dangerous [[Pyelonephritis|kidney infection]] that is characterized by [[pus]] accumulation in the [[Collecting duct system|renal collecting system]].<ref name="Kumar Khan Kishore Gopal 2016 p. ">{{cite journal | last1=Kumar | first1=Lanka Praveen | last2=Khan | first2=Irshad | last3=Kishore | first3=Amit | last4=Gopal | first4=Manoj | last5=Behera | first5=Vineet | title=Pyonephrosis among Patients with Pyelonephritis Admitted in Department of Nephrology and Urology of a Tertiary Care Centre: A Descriptive Cross-sectional Study | journal=Journal of Nepal Medical Association | publisher=Nepal Medical Association | volume=61 | issue=258 | date=July 1, 2016 | pages=111–114 | pmid=37203981 | doi=10.31729/jnma.8015 | pmc=10088997 }}</ref> It is linked to renal collecting system blockage and suppurative renal [[parenchyma]]l destruction, which result in complete or nearly complete [[kidney failure]].<ref name="Scârneciu Constantina Grigorescu Maxim 2015 pp. 45–48">{{cite journal | last1=Scârneciu | first1=Ioan | last2=Constantina | first2=Alexandru | last3=Grigorescu | first3=Dan | last4=Maxim | first4=Laurian | title=Pyonephrosis: diagnosis and treatment: report of 65 cases | journal=Jurnal Medical Brasovean | date=2015 | issn=2247-4706 | pages=45–48 |url=https://webbut.unitbv.ro/index.php/jmb/article/view/4729 | access-date=December 28, 2023}}</ref>

==Signs and symptoms==
Clinical symptoms in patients with pyonephrosis can range from frank [[sepsis]] (15%) to asymptomatic [[bacteriuria]]. Upon physical examination, the hydronephrotic kidney may be linked to a palpable [[abdominal mass]].<ref name="Peterson 2023 z532"/> On rare occasions, the hydronephrotic kidney infection may burst spontaneously into the [[peritoneal cavity]], resulting in diffuse [[peritonitis]] and [[sepsis]] in certain patients.<ref name="Quaresima Manzelli Ricciardi Petrou 2011 p. ">{{cite journal | last1=Quaresima | first1=Silvia | last2=Manzelli | first2=Antonio | last3=Ricciardi | first3=Edoardo | last4=Petrou | first4=Athanasios | last5=Brennan | first5=Nicholas | last6=Mauriello | first6=Alessandro | last7=Rossi | first7=Piero | title=Spontaneous intraperitoneal rupture of pyonephrosis in a patient with unknown kidney carcinosarcoma: a case report | journal=World Journal of Surgical Oncology | publisher=BMC | volume=9 | date=2011 | pmid=21486444 | doi=10.1186/1477-7819-9-39 | page=39| doi-access=free | pmc=3087700 }}</ref>

==Cause==
Pyonephrosis can result from an upper [[urinary tract infection]] combined with blockage and [[hydronephrosis]].<ref name="Peterson 2023 z532">{{cite journal | last=Peterson | first=Andrew C | title=Pyonephrosis: Practice Essentials, Etiology, Prognosis | website=emedicine.medscape.com | date=December 14, 2023 |url=https://emedicine.medscape.com/article/440548-overview#a2 | access-date=December 28, 2023}}</ref>

==Diagnosis==
When a patient has suspected pyonephrosis, the initial workup should consist of a [[complete blood count]], serum chemistry with [[blood urea nitrogen]] (BUN) and [[creatinine]], blood cultures, and [[urinalysis]] with culture<ref name="M R ML p. ">{{cite journal | last1=M | first1=St Lezin | last2=R | first2=Hofmann | last3=ML | first3=Stoller | title=Pyonephrosis: diagnosis and treatment | journal=British Journal of Urology | date=1992 | publisher=Br J Urol | volume=70 | issue=4 | pages=360–363 | issn=0007-1331 | pmid=1450841 | doi=10.1111/j.1464-410x.1992.tb15788.x |url=https://pubmed.ncbi.nlm.nih.gov/1450841/ | access-date=December 28, 2023 }}</ref>

It is generally not recommended to perform routine radiographic imaging on patients who have simple [[urinary tract infection]]s. When patients do not improve quickly with appropriate [[antibiotic]]s, however, appropriate radiographic studies help diagnose pyonephrosis, emphysematous pyelonephritis, and renal and/or perirenal abscesses.<ref name="DA BR p. ">{{cite journal | last1=DA | first1=Baumgarten | last2=BR | first2=Baumgartner | title=Imaging and radiologic management of upper urinary tract infections | journal=The Urologic Clinics of North America | date=1997 | publisher=Urol Clin North Am | volume=24 | issue=3 | pages=545–569 | issn=0094-0143 | pmid=9275978 | doi=10.1016/s0094-0143(05)70401-8 |url=https://pubmed.ncbi.nlm.nih.gov/9275978/ | access-date=December 28, 2023 }}</ref>

==Treatment==
Together with intravenous [[antibiotic]]s, drainage<ref name="S A MJ RN p. ">{{cite journal | last1=S | first1=Ramsey | last2=A | first2=Robertson | last3=MJ | first3=Ablett | last4=RN | first4=Meddings | last5=GW | first5=Hollins | last6=B | first6=Little | title=Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi | journal=Journal of Endourology | date=2010 | publisher=J Endourol | volume=24 | issue=2 | pages=185–189 | issn=1557-900X | pmid=20063999 | doi=10.1089/end.2009.0361 |url=https://pubmed.ncbi.nlm.nih.gov/20063999/ | access-date=December 28, 2023 }}</ref>—either percutaneous or retrograde with a ureteral stent<ref name="ZL T ST DR p. ">{{cite journal | last1=ZL | first1=Barbaric | last2=T | first2=Hall | last3=ST | first3=Cochran | last4=DR | first4=Heitz | last5=RA | first5=Schwartz | last6=RM | first6=Krasny | last7=MW | first7=Deseran | title=Percutaneous nephrostomy: placement under CT and fluoroscopy guidance | journal=AJR. American Journal of Roentgenology | date=1997 | publisher=AJR Am J Roentgenol | volume=169 | issue=1 | pages=151–155 | issn=0361-803X | pmid=9207516 | doi=10.2214/ajr.169.1.9207516 |url=https://pubmed.ncbi.nlm.nih.gov/9207516/ | access-date=December 28, 2023 }}</ref>—has become the cornerstone of treatment since the development of [[ultrasonography]] and [[computed tomography]] (CT) scanning. Drainage offers a great outcome with low rates of morbidity and mortality. A [[CT scan]] or ultrasound-guided drainage greatly reduces the need for a nephrectomy.<ref name="Peterson 2023 z532"/>

==See also==
* [[Pyelonephritis]]
* [[Nephrotic syndrome]]

==References==
{{Reflist}}

==Further reading==
* {{cite book | last1=Pappas | first1=Diane E. | last2=Hendley | first2=J. Owen | last3=Meissner | first3=H. Cody | last4=Nayak | first4=Jennifer Lynn | last5=Caserta | first5=Mary T. | last6=Arvin | first6=Ann M. | last7=Ross | first7=Shannon A. | last8=Kimberlin | first8=David W. | last9=Prober | first9=Charles G. | title=Principles and Practice of Pediatric Infectious Diseases | chapter=Urinary Tract Infections, Renal Abscess, and Other Complex Renal Infections | publisher=Elsevier | date=January 1, 2023 | pages=352–358.e4 | doi=10.1016/B978-0-323-75608-2.00048-3 | isbn=9780323756082 |chapter-url=https://www.sciencedirect.com/science/article/abs/pii/B9780323756082000483 | access-date=December 28, 2023 | ref=none}}
* {{cite book | last1=Yu | first1=Mei-Hong | last2=Tu | first2=Yue-Xing | last3=Wityk | first3=Paweł | last4=Rak | first4=Janusz | last5=Fandilolu | first5=Prayagraj M. | last6=Sonawane | first6=Kailas D. | last7=Zhang | first7=Zao | last8=Hayashi | first8=Rick | last9=Mostofi | first9=Keyvan | last10=Daryabin | first10=Mathieu | last11=Kuljanin | first11=Miljan | last12=Lajoie | first12=Gilles A. | title=Principles and Practice of Pediatric Infectious Diseases | chapter=Renal Abscess and Other Complex Renal Infections | publisher=Elsevier | date=January 1, 2012 | pages=343–345.e1 | doi=10.1016/B978-1-4377-2702-9.00050-7 | isbn=9781437727029 |chapter-url=https://www.sciencedirect.com/science/article/abs/pii/B9781437727029000507 | access-date=December 28, 2023 | ref=none}}

==External links==
{{Medical resources
| ICD11           = {{ICD11|GB58}}
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| MeshID          = D053018
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| SNOMED CT       = 48631008
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| eMedicineSubj   = med
| eMedicineTopic  = 2851
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{{Nephrology}}

[[Category:Medical terminology]]
[[Category:Kidney diseases]]