Pyonephrosis: diagnosis and treatment: a review of 14 cases.

Prior to the introduction of antibiotics, the treatment of pyelonephrosis f requently consisted of nephrectomy to remove the non-functional kidney, whi ch was a potentially dangerous source of systemic infection. This approach was later modified as a result of the advances made in antibiotic therapy, and included vigorous antibiotic treatment and prompt drainage of the kidne y. At present, percutaneous nephrostomy provides a means of draining off th e pus and determining a possible residual renal function. In this study, 14 cases of pyonephrosis were observed over a 7-month period. Lumbar pain was noted in 70% of cases, painful lumbar contact in 5 cases and fever, shiver ing and pyuria in all cases. Cytobacteriological urine analysis showed the presence of Escherichia coli in 7 patients, Proteus in 4 patients, and in 3 cases abacterial leucocyturia; in 2 patients with only one functional kidn ey, renal insufficiency was observed. In all cases, the diagnosis was confi rmed by ultrasonography. The main etiological factors were urinary lithiasi s in 10 patients (71%), followed by uropathy of the pyeloureteral junction in 4 patients (29%). Treatment consisted of primary nephrectomy in 10 cases ; in 3 cases, primary nephrostomy was performed with a positive outcome and recovery of renal function in 2 subjects; in one case of renal failure tre ated by nephrostomy followed by conservative surgery, the patient did not s urvive. In conclusion, nephrectomy is advocated as the treatment of choice in the case of a damaged kidney and a normal contralateral kidney. Conserva tive treatment should be envisaged particularly in the case of a single kid ney, or if the patient's state of health is poor. The best treatment consis ts of the detection and cure of the lithiasis which is the main etiological factor in this pathology. (C) 2000 Editions scientifiques et medicales Els evier SAS.