Urgent nephrostomy is done in: (DBC June 2011)
|B||Pelviureteric junction obstruction|
a. Infected hydronephrosisis bacterial infection in a hydronephrotic kidney.
b. The term pyonephrosis refers to infected hydronephrosis associated with suppurative destruction of the parenchyma of the kidney, in which there is total or nearly total loss of renal function .
c. Where infected hydronephrosis ends and pyonephrosis begins is difficult to determine clinically.
d. Rapid diagnosis and treatment of pyonephrosis are essential to avoid permanent loss of renal function and to prevent sepsis.
e. The patient is usually very ill, with high fever, chills, flank pain, and tenderness.
f. A previous history of urinary tract calculi, infection, or surgery is common.
g. Bacteriuria may not be present if the ureter is completely obstructed.
h. The ultrasonographic diagnosis of infected hydronephrosis depends on demonstration of internal echoes within the dependent portion of a dilated pyelocalyceal system.
i. CT is nonspecific .
j. Typically, the obstruction is of long standing, and excretory urography shows a poorly functioning or nonfunctioning hydronephrotic kidney.
k. Ultrasound demonstrates hydronephrosis and fluid debris levels within the dilated collecting system .
l. The diagnosis of pyonephrosis is suggested if focal areas of decreased echogenicity are seen within the hydronephrotic parenchyma.
m. Once the diagnosis of pyonephrosis is made, the treatment is initiated with appropriate antimicrobial drugs and drainage of the infected pelvis.
n. A ureteral catheter can be passed to drain the kidney, but if the obstruction prevents this, a percutaneous nephrostomy tube should be place.
o. When the patient becomes hemodynamically stable, other procedures are usually needed to identify and treat the source of the obstruction