Pyonephrosis

The kidney becomes a multilocularsac containing pus or purulent urine. Pyonephrosis results from infection of a hydronephrosis, following acute pyelonephritis or, most commonly, arises as a complication of renal calculus disease. Pyonephrosis is usually unilateral.

Clinical features

   The classical triad of symptoms is anaemia, fever and  a swelling in the loin. When the condition arises as an infected hydronephrosis, the swelling may be very large and the pyrexia very high and associated with rigors. Symptoms of cystitis may be prominent.

Investigatigation

   USG may show a calculus and will demonstrate of the pus –filled collecting system.

Treatment

   Pyonephrosis is a surgical emergency because the patient is threatened with permanent renal damage and lethal septicaemia. Parenteral antibiotics should be given immediately and the kidney drained. If the pus is too thick to be aspirated through a large percutaneous nephrostomy, consider open nephrostomy. In cases in which there is a stone, the stone should be removed. Nephrectomy may be appropriate when the kidney is destroyed and function on the other side is good.