ACUTE PURULENT BILATERAL PYELONEPHRITIS: DIAGNOSIS AND TREATMENT

Abstract

Background. Acute purulent bilateral pyelonephritis is the most severe form of acute pyelonephritis. The disease is often accompanied with oligo- or anuria and is complicated by urosepsis. Purpose of the study. To analyze information content of diagnostic methods and immediate results of treatment of patients with acute bilateral pyelonephritis in the phase of purulent inflammation. Material and methods. 44 patients with acute bilateral pyelonephritis were observed. The purulent process in both kidneys was diagnosed by ultrasound and contrast-enhanced computed tomography (CT). Urosepsis was laboratory confirmed in 34 patients. All patients were operated on both sides. Organ-preserving surgeries were performed in 43 cases, and both kidneys were removed in one patient. Histological examination of fragments of the kidney parenchyma confirmed the purulent process in 41 patients. After surgery all patients received targeted antibacterial and detoxification therapy. Results. After operations 5 patients died due to the progression of multiple organ failure. After surgery two patients required hemodialysis due to the development of anuria. 37 patients were discharged from the clinic in a satisfactory condition. 1 year after the operation 19 were diagnosed with chronic renal failure stage III. Conclusions. 1. CT with contrast enhancement is the best method for detecting foci of purulent destruction in the renal parenchyma. 2. Acute purulent bilateral pyelonephritis in 77.3% is complicated by urosepsis which requires intensive complex treatment: surgical debridement of purulent foci in both kidneys followed by long-term targeted antibacterial and detoxication therapy. 3. The prognosis for acute purulent bilateral pyelonephritis is always uncertain for life and poor for recovery.