Urinary tract infection cont,

Perinephric abscess Infection and pus collection in the perinephric space within Gerota’s fascia

Source of infection Hematogenous, lymphatic infected peri renal hematoma or urinoma, extension from a nearby infected focus like appendicitis untreated pyonephrosis or renal abscess. Rarely mycobacterial perinephric abscess may occur.

Clinical pictures High swinging pyrexia, tenderness and fullness in the loin. The symptoms are marked if the infection started at lower pole because the upper pole is hidden by thoracic cage.

Investigations GUE: normal unless the abscess is extended from renal pathology. WBC: neutrophil leukocytosis. U/S: pus collection around the kidney with or without hydronephrosis. KUB: obscured psoas shadow, spine scoliosis,. CT scan & MRI: diagnostic.

Treatment Drainage is the principle treatment of pus collection anywhere in the body. Under antibiotic cover lumber incision is made, all loculi destructed, pus drained and wound closed over a tube drain.

Drinage of perinephric abscess

Renal carbuncle (renal cortical abscess) It arises as a result of blood born micro-organism especially staphylococcus aureus from a skin lesion in debilitated or immune compromised patient like diabetics. Rarely the abscess arises from infected cortical hematoma or cyst.

Ill defined tender renal mass, persistent pyrexia and leukocytosis. Clinical pictures Ill defined tender renal mass, persistent pyrexia and leukocytosis.

Investigations GUE: normal or pyuria. U/S: cystic cortical lesion with internal echoes. IVU: space occupying lesion, which may be confused with renal tumor. CT scan & MRI: diagnostic.

U/S cystic lesion with internal echoes (renal abscess)

Retrograde pyelography: Left renal abscess

CT scan: right renal abscess

CT scan: Left renal abscess

If pus is too thick to be drained by percutaneous needle aspiraion Treatment Drainage is the principle treatment of pus collection anywhere in the body. If pus is too thick to be drained by percutaneous needle aspiraion Under antibiotic cover lumber incision is made, all loculi destructed, pus drained and wound closed over a tube drain.

Specific infection of the kidney

Renal Tuberculosis Bacteria: Mycobacterium TB Pathogenesis: Hematogenic Start unilateral , late bilateral affection. The 1st lesion starts usually in the pyramids Chronic: Asymptomatic until late stage

TB granuloma, caseation, open to the calyces. Renal destruction, calcification. The ureteric upper & lower 1/3rd is affected Ureteral & bladder involvement is commonly secondary

RENAL TB

Clinical picture Always suspect if: Endemic area Age : 20----30 year Chronic symptoms Non responsive UTI to adequate therapy. Unexplained hematuria. Night sweating, Wt loss Chronic renal sinuses. TB is the most common opportunistic infection in AIDS patients

Investigations GUE : RBC , Sterile acid pyurea. -ve urine C&S Three successive morning urine samples for AFB. 24 hours urine collection for AFB. TB culture & sensitivity. ESR increased WBC total & differential. KUB: Renal calcification IVU CXR Cystoscopy: for lower tract involvement.

Treatment Medical: Surgical: If complicated No clinical control Correct obstruction Nephrectomy.

Bilharziasis Trematode: schistosoma haematobium Male: female 3:1 Endemic in Nile valley, Iraq, & middle east in general. Marshes & slow running fresh water is the habitat of the fresh water snail ( bulinus truncatus ) which is the intermediate host.

Clinical features Urticaria ( swimming itch ) Fever , sweating Hematuria: intermittent, terminal Lymphadenopathy & splenomegaly

Investigations GUE : early morning samples for several consecutive days – ovae with terminal spines Leukocytosis – eosinophilia Cystoscopy Bilharzial pseudotubercles , nodules, sandy patches, ulceration, fibrosis, granulomas, papillomas, carcinoma (SCC).

Imaging study KUB U/S

IVU

Treatment Antimony e.g. praziquantel & metriphonate Papilloma : endoscopic removal Carcinoma : radical cystectomy

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