How to treat renal abscess

Kidney abscess is a purulent infection that mainly causes serious damage to people's kidneys. Patients with renal abscess will have very serious infection of renal tissue, and some will even form lumps in the kidneys. Patients will feel obvious abdominal pain. Renal abscess requires prompt treatment, otherwise severe infection may lead to kidney tissue necrosis. So, how should renal abscess be treated?

Renal abscess refers to a purulent infection focus in a certain part of the body or bacteria that reach the renal cortex through the blood, causing local or complete renal tissue infection. Renal abscess is a purulent infection of the renal cortex. It is a serious infection caused by Staphylococcus aureus entering the renal cortex through the blood. In the early stage, it is edema accompanied by a varying number of small abscesses. Small abscesses can combine to form an infectious mass. In severe cases, when necrosis and liquefaction are obvious, a typical renal abscess is formed. It is mostly caused by blood-borne infection, but can also be caused by retrograde urinary tract infection.

The diagnosis of renal abscess is usually not difficult when combined with clinical and laboratory data. CT examination can clearly show the renal outline, the space around the kidney and its relationship with adjacent structures, which can guide clinical treatment. CT is difficult to diagnose for patients with atypical clinical manifestations and early abscesses, and it is not easy to differentiate them from renal cell carcinoma. It requires a combination of clinical, short-term follow-up, and even fine needle aspiration biopsy to confirm the diagnosis. In general, regardless of the location and extent of the abscess, it will cause varying degrees of functional impairment in the affected kidney, manifested as weaker CT enhancement than that of the normal kidney. This is an important feature of renal inflammatory lesions. MRI is useful in the examination of renal abscesses but is not a routine examination.

Treatment principles

Ultrasound-guided puncture treatment for renal abscess is widely used because of its small damage, low cost, and few complications. It can clearly show the location of the abscess cavity in the kidney and determine the skin puncture point, angle, and depth, thereby greatly improving the success rate of puncture. It can also avoid the pain caused by surgical trauma to patients and shorten the course of the disease.

When ultrasound-guided puncture is used to treat renal abscess, the key to successful puncture is accurate ultrasound positioning. Due to its unique beam thickness artifact, ultrasound guidance can easily show the puncture needle that is close to the outside of the abscess as entering the abscess. Therefore, the choice of puncture path is very important. First of all, before the operation, the appropriate body position and puncture site should be selected according to the location of the abscess cavity in the kidney and the distance from the epidermis, including the puncture point, needle insertion angle and depth. Secondly, avoid the large blood vessels in the kidneys and the liver, spleen, lungs, intestines, etc. During the suction process, try to flush and drain the pus as much as possible before injecting the medicine. Before the operation, explain the puncture steps to the patient to relieve his/her nervousness, and ask the patient to hold his/her breath to prevent deviation due to breathing during puncture.

If renal abscess does not liquefy to form an abscess in the early stage or there is a lot of necrotic material in the abscess, the pus is viscous and a strong light mass appears on the sonogram, which is very similar to a solid mass in the kidney. It is easy to misdiagnose as renal cancer or renal tuberculosis. Dynamic observation and puncture are helpful for differential diagnosis and can improve the diagnostic ability of abscesses. According to relevant reports, the diagnosis rate of renal abscesses guided by ultrasound can reach 100%. The pus obtained by puncture can be subjected to routine examinations and cytology, biochemistry, bacteriology and drug sensitivity tests, which is helpful for the diagnosis of the cause of the abscess and is of great help to clinical drug treatment.