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
- Monitoring for postprocedural bacteremia and sepsis
- Consideration of third-generation cephalosporin ceftazidime as the preferred antibiotic regimen
The use of PCN in neonatal renal candidiasis has also been shown to be valuable in eradicating funguria and is an attractive alternative to surgical decompression 1. In contrast, retrograde ureteral stenting is also a viable option, particularly in patients with obstructive pyelonephritis/pyonephrosis, and can be used in conjunction with antibiotic therapy as a first-line treatment option 1.
Overall, the management of hydronitis suppurative should prioritize PCN as the primary method of urinary tract decompression, with careful consideration of antibiotic regimens and monitoring for potential complications.
From the Research
Definition and Diagnosis of Hydronitis Supperative
- Hydronitis supperative, also known as suppurative pyelonephritis, is a severe infection of the kidney that can lead to the formation of pus and abscesses 2.
- The diagnosis of suppurative pyelonephritis is typically made based on a combination of clinical symptoms, laboratory tests, and imaging studies, such as computed tomography (CT) scans 3.
Risk Factors and Complications
- Certain risk factors, such as old age, male sex, deranged renal function, and presence of disseminated intravascular coagulation, are associated with an increased risk of mortality from suppurative pyelonephritis 2.
- Patients with suppurative pyelonephritis are at risk of developing severe complications, including sepsis, shock, and multiorgan failure 2, 3.
Treatment Options
- Treatment options for suppurative pyelonephritis include antibiotic therapy, drainage of abscesses, and surgical intervention, such as nephrectomy 2, 3.
- In severe cases, immediate nephrectomy may be necessary to prevent further complications and improve outcomes 3.
- The choice of treatment depends on the severity of the infection, the presence of underlying medical conditions, and the patient's overall health status 4.