ОСТРЫЙ ГНОЙНЫЙ ПИЕЛОНЕФРИТ ЕДИНСТВЕННОЙ ПОЧКИ

Abstract

Background. One of the life-threatening diseases among patients with a single kidney is acute purulent pyelonephritis (APP). The disease is accompanied by oliguria or anuria and in many cases comes with the development of multiple organ dysfunction. Objectives. To present the features of the clinical manifestations of APP of a solitary kidney, the results of clinical and laboratory examination, the role of kidney imaging methods (USG, MRI and contrast-enhanced CT) in identifying foci of purulent destruction in the parenchyma, and the immediate results of treatment of patients with APP of a solitary kidney. Material and methods. 10 patients with APP of a solitary kidney were observed. The role of imaging methods (USG, CT and MRI) of the kidney in the detection of purulent destruction in parenchyma is shown. Methods of treating patients are considered: open organ-preserving surgery, nephrectomy; installation of an internal ureteral stent followed by antibiotic therapy and puncture nephrostomy followed by antibiotic therapy. Results. The best immediate results were noted in the group of patients who underwent open organ-preserving surgery in the volume of decapsulation of the kidney, excision of carbuncles, opening of abscesses and drainage of the calices-pelvis system of the kidney with nephrostomy. 3 out of 10 patients needed hemodialysis. Conclusion. Open organ-preserving surgery remains a reliable adequate method of surgical treatment of APP of a solitary kidney. In case of a single focus of destruction in the kidney parenchyma up to 3 cm in diameter or with signs of apostematous pyelonephritis, an effective method of treatment is the installation of an internal ureteral stent followed by antibiotic therapy. 30% of patients with APP need hemodialysis treatment.