Carbuncle kidney

Carbuncle - sided metastatic purulent lesion kidney - arises from the peripheral suppurative focus in an organism (a boil, felon, purulent mastitis, tonsillitis, sinusitis, and so on) in the case of infectious embolus clog large final vessel kidneys. Forms of ischemic heart attack, further exposed purulent melt.
Carbuncle kidneys can occur in chronic inflammatory process in the urinary tract.
The causative agent of anthrax is often aureus, rarely Streptococcus.
Macroscopically carbuncle kidney is a protrusion on the surface of the kidney that wedge penetrates into the renal parenchyma and consists of ischemic or necrotic tissue and small miliary ulcers (Fig. 73). Fat capsule may also be involved in the inflammatory process.
The clinical picture is similar to the pattern apostatizing jade. Suddenly the temperature rises up to 38-40°, accompanied by spectacular chills, there are a pain in the lumbar region and develops a picture of severe sepsis.
In the early stages of infiltration carbuncle kidneys may be a reverse development. In introducing its melting ulcer emptied or the renal pelvis, and then there is a cure itself or in okolopochechnuyu fibre that leads to the development of purulent paranemia.
When the location of anthrax in the lower pole of the kidney or the involvement of the fat capsules sometimes manage to probe increased painful kidney.
Urine remains normal or contains a single leukocytes and erythrocytes. At the break of anthrax in the pelvis urine becomes known.
Radiography of the thorax detects pleural effusion with sick sinus side. On the overview there are no x-ray contours of lumbar muscles (paranemia). Bilateral retrograde pyelography made without delay of breath, detects mobility buds on the healthy side (blurry contours of the pelvis) and the stillness of the kidney to the patient's side (clear image lohanki), the deformation and the compression of the cups and warp them.
In the initial stages of the disease massive doses of antibiotics - crystalline penicillin 500 000 IU 2 times a day intravenously, streptomycin 1-2 grams a day intramuscularly, syntomycin 0.5 g 4 times a day, biomitsin 0.2-0.3 g 5 times a day - in some cases lead to a cure.
More often, however, we have to expose the kidney to produce decapsulation her and dissection of carbuncle or resection of the kidney.

Fig. 73. Carbuncle upper pole of the kidney.