Overview.
Yellow granulomatous pyelonephritis is a rare and severe form of chronic bacterial pyelonephritis. The disease may produce diffuse renal parenchymal destruction, usually with only unilateral renal involvement, rarely with bilateral lesions. It is characterized by renal parenchymal damage, granulomatous abscesses, and a large accumulation of fat-containing macrophages in the renal interstitium. Fat-containing macrophage accumulation. Granulomas arise mainly in association with bacterial infection and macrophage lysis dysfunction affecting the digestion of bacterial products. The disease can develop at any age, but is more common in the 50-70 year olds; there are significantly more female patients than male.
Etiology
Caused by bacterial infection. Most are Escherichia coli and Proteus, and penicillin-resistant Staphylococcus aureus is occasionally seen. It is also caused by local metabolic abnormalities due to aggravation of urinary tract obstruction, chronic ischemia and poor intrarenal lymphatic drainage.
Symptoms
The disease usually has only unilateral renal involvement, rare bilateral lesions; the vast majority of patients with pain in the renal region and recurrent urinary tract infections, urinary frequency, urinary urgency, urinary pain, mostly irregular fever, general malaise, malaise, anorexia, emaciation, and constipation. Most patients have a history of stones, urinary tract obstruction or diabetes mellitus, and half of the patients can palpate a mass in the lumbar region, accompanied by hypertensive manifestations.
Examination
1. Laboratory examination
Leukocyturia is common, hematuria is rare. Urine bacterial culture is positive in most cases, with Escherichia coli, Escherichia coli, and penicillin-resistant Staphylococcus aureus most common, and penicillin-resistant Staphylococcus aureus can also be seen in the morning urine centrifugation, and foam cells can be seen in the sediment smear, with a positivity rate of more than 80%; if more than 5 foam cells are seen in a section, the disease can be diagnosed in general. Blood tests commonly show anemia, increased white blood cell count and accelerated sedimentation.
2. KUB (kidney-ureter-bladder) photography
Unilateral enlarged renal shadow can be seen. IVP can show non-functioning kidney, renal or ureteral stone, calyceal deformity, cystic lesion or cavity in the mass.
3.CT scanning examination
CT scan can show multiple nodular or large mass-like hypodense lesions in the kidney, and stones and calcification foci in the renal pelvis or collecting duct system can be seen; it can also be manifested as enlarged deformity at one pole of the kidney or confined renal mass, isointense or slightly hyperintense, but enhancement after enhancement is not obvious; sometimes it can invade perirenal interstitial space and lumbar muscle.
4. Magnetic resonance imaging (MRI) and ultrasound examination
Magnetic resonance imaging (MRI) and B-ultrasound are also helpful for diagnosis. B-ultrasound can show enlarged kidneys and liquid dark areas in the kidneys.
Diagnosis
The possibility of yellow granulomatous pyelonephritis should be considered in those with a history of chronic urinary tract infections, positive foam cells on centrifugal sediment smear of morning urine, and positive imaging findings of certain suspicious lesions. x-ray changes include unilateral renal enlargement, intravenous pyelogram (IVP) showing a nonfunctioning kidney, and renal and/or ureteral findings of calculi. As well as characteristic findings on CT and MRI values. Based on these features, a diagnosis or a preoperative proposed diagnosis can be made in 40% of cases. In addition, urine bacterial cultures are almost always positive in patients with this disease, with Proteus mirabilis and Escherichia coli being the most common, due to the high prevalence of Escherichia coli infections, and similarly in neopenicillin I-resistant Staphylococcus aureus infections. Renal histopathologic examination is important in confirming the diagnosis of the disease.
Treatment
Surgery is an important treatment for this disease, and the affected kidneys are mostly resected and heal well with treatment. As the differential diagnosis of this disease from renal cancer and renal tuberculosis is difficult, it is easy to cause misdiagnosis before surgery. In surgical treatment, it is necessary to recognize the difficulty and increased risk of surgery caused by the pathological changes formed by the spread of the lesion. An appropriate surgical plan should be drawn up according to the clinicopathologic staging in order to improve the safety and success of surgery.
The treatment method of preserving kidney is rarely used, so whether the correct diagnosis can be made before surgery is very important for the choice of treatment of this disease. The therapeutic method of kidney preservation surgery deserves further research and application.
Questions you may be concerned about
What are the treatments for yellow granulomatous pyelonephritis?
For yellow granulomatous pyelonephritis, surgical treatment, including kidney preservation surgery, nephrectomy, followed by reasonable medication, is usually recommended.
1.Surgical treatment:
(1) Preserved Kidney Surgery: if the current rate of progression of the disease is slow, you can choose to do preserved kidney surgery. If there are stones present in the ureter, it is recommended to incise and remove the stones as soon as possible, and if necessary, kidney drainage can be performed.
(2) Nephrectomy: If there is diffuse destruction of renal tissue, it is usually recommended to remove the necrotic kidney as soon as possible so that the kidney will not continue to be destroyed.
(2) Medication: If there is postoperative combined inflammatory infection that leads to poor recovery, oral antibiotics, such as ampicillin and streptomycin, can be taken as prescribed by the doctor.
Patients with yellow granulomatous pyelonephritis should consult a regular hospital in time and follow the doctor’s instructions for standardized treatment. The above medication should follow the doctor’s instructions, avoid taking medication without authorization, so as not to aggravate the condition.