From the Guidelines
Hydronitis suppurative, also known as pyonephrosis, is a life-threatening condition that requires immediate urinary tract decompression, which can be achieved through percutaneous nephrostomy (PCN) or retrograde ureteral catheterization, with PCN being the preferred method in unstable patients or those with multiple comorbidities. The decision to perform PCN depends on clinical symptoms of sepsis, and recent data suggest that serum C-reactive protein may be a useful parameter in making this decision 1.
In patients with pyonephrosis, PCN is usually technically successful and results in marked clinical improvement, yielding important bacteriological information and altering antibiotic treatment regimens 1. A recent study demonstrated the superiority of third-generation cephalosporin ceftazidime versus fluoroquinolone ciprofloxacin in both clinical and microbiological cure rates, with improved early and long-term cure rates in those who received PCN versus ureteral stent 1.
Key considerations in the management of hydronitis suppurative include:
- Emergent drainage with PCN or retrograde ureteral catheterization in unstable patients or those with multiple comorbidities
- Use of preprocedural antibiotics when urosepsis is suspected or known to be present
- Administration of antifungal agents into the renal collecting system in cases of neonatal renal candidiasis
- Monitoring for postprocedural bacteremia and sepsis
The choice between PCN and retrograde ureteral stenting depends on local practice preferences, with both options being considered first-line treatment options for obstructive pyelonephritis/pyonephrosis 1. Overall, PCN is a lifesaving procedure that can provide significant clinical improvement in patients with pyonephrosis, and its use should be considered in all cases of hydronitis suppurative.
From the Research
Definition and Types of Pyelonephritis
- Pyelonephritis is a bacterial infection of the kidney and renal pelvis, which can be acute or chronic 2.
- There are different types of pyelonephritis, including acute uncomplicated pyelonephritis, emphysematous pyelonephritis, and suppurative pyelonephritis 3, 4, 5.
Suppurative Pyelonephritis
- Suppurative pyelonephritis is a severe form of pyelonephritis characterized by the formation of pus in the kidney 4.
- It is often associated with urinary tract obstruction, sepsis, and multiorgan failure 4, 5.
- Risk factors for suppurative pyelonephritis include old age, male sex, deranged renal function, and presence of disseminated intravascular coagulation 4.
Treatment of Suppurative Pyelonephritis
- Treatment of suppurative pyelonephritis typically involves antibiotics, drainage of the urinary tract, and supportive care in an intensive care unit 4, 5.
- In severe cases, radical nephrectomy may be necessary to remove the infected kidney 5.
- Early recognition and treatment of suppurative pyelonephritis are crucial to prevent complications and improve outcomes 4, 5.
Antibiotic Therapy
- Antibiotic therapy is essential in the treatment of pyelonephritis, including suppurative pyelonephritis 6, 3, 2.
- The choice of antibiotic depends on the severity of the infection, the presence of underlying medical conditions, and the susceptibility of the causative organism 6, 2.
- Fluoroquinolones and trimethoprim/sulfamethoxazole are commonly used antibiotics for the treatment of pyelonephritis, but resistance is a growing concern 6, 2.