Circulatory condition in kidney patients with purulent pyelonephritis

Abstract

Relevance. Urinary tract infections are among the most common infectiousdiseases encountered in the practice of doctors of various specialties, both at the outpatient and hospital stages. In recent years, there has been an increase in the incidence of acute pyelonephritis. The management of patients with acute complicated pyelonephritis requires further study aimed at optimizing the diagnostic algorithm and treatment methods. Objective. Studying the state of blood circulation in the kidney in patients with purulent pyelonephritis and improving the quality of treatment of these patients by introducing our own developed methodology. Materials and methods. In the Regional clinical hospital (Barnaul city, Russia), in the conditions of the urological department, the author personally examined and operated on 30 patients with purulent pyelonephritis according to his own method with an established diagnosis of purulent pyelonephritis. On the first day, all patients underwent retroperitoneoscopic decapsulation of the kidney on the affected side in combination with regional arterial infusion of alprostadil for 3 days. All patients underwent general clinical examination, multispiral computed tomography (MSCT) of the kidneys with bolus contrast enhancement, duplex scanning of renal vessels, and morphological examination of the material before and after the operation. Results. In all cases, the postoperative period proceeded favorably with a shorter treatment time. On the first day after surgery, patients noted a decrease in the intensity of pain in the area of the affected kidney. When comping the data of MSCT of the kidneys with bolus contrast, obtained in patients before treatment, the disappearance of foci of destruction in the kidney and a pronounced restoration of the previously lost blood flow of the kidney on the side of the lesion in the early stages are determined. Nephrectomy was not performed in any case. Conclusion. Each of the stages of the proposed method for the treatment of acute purulent pyelonephritis is an integral part of the technique as a whole; each stage is necessary to influence its level of the vascular bed and parenchyma in the area of its microabscesses and zones of infection. The method allows to achieve restoration of blood circulation in the kidney with the opening of antibiotics access to the organ parenchyma.