Watercolour drawing of a dissected kidney, showing a condition of acute pyonephrosis. The ureter is blocked by a calculus and several calculi are seen lying in the sacculi.
Pyonephrosis (
Greekpyon "pus" + nephros "kidney")[1] is a dangerous
kidney infection that is characterized by pus accumulation in the renal collecting system.[2] It is linked to renal collecting system blockage and suppurative renal
parenchymal destruction, which result in complete or nearly complete
kidney failure.[3]
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.[4] On rare occasions, the hydronephrotic kidney infection may burst spontaneously into the
peritoneal cavity, resulting in diffuse
peritonitis and
sepsis in certain patients.[5]
It is generally not recommended to perform routine radiographic imaging on patients who have simple
Urinary tract infections. When patients do not improve quickly with appropriate
antibiotics, however, appropriate radiographic studies help diagnose pyonephrosis, emphysematous pyelonephritis, and renal and/or perirenal abscesses.[7]
Treatment
Together with intravenous
antibiotics, drainage[8]—either percutaneous or retrograde with a ureteral stent[9]—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.[4]