ACUTE PURULENT PYELONEPHRITIS (LITERATURE REVIEW). PART I – DIAGNOSTICS

The diagnosis of acute pyelonephritis is based on the clinical and laboratory syndrome: pain in the lumbar region, an increase in the body temperature to 38°C and above with chills; some patients develop dysuria; leukocytosis with a left shift in the white blood cell count, elevated erythrocyte sedimentation rate, increased C-reactive protein and fibrinogen, leukocyturia and bacteriuria. The syndrome is similar in both acute serous pyelonephritis and in purulent forms of acute pyelonephritis. To exclude or confirm such forms as renal carbuncle and abscess, emphysematous pyelonephritis, necrosis of the renal papillae, pyonephrosis ultrasound with dopplerography as well as computed tomography with contrast enhancement are used. This allows us to identify a number of absolute signs of focal purulent lesion of the renal parenchyma in such patients. Detection of changes in the kidneys of patients with acute pyelonephritis in the form of probable echoscopic and tomographic signs requires a number of laboratory tests: C-reactive protein, presepsin and procalcitonin blood levels, immunogram. Any exceeding of the threshold values of these indicators in the presence of probable echoscopic and tomographic signs justifies the diagnosis of acute purulent pyelonephritis. The results of using kidney visualization methods and special laboratory research methods determine the development of an adequate treatment plan for patients with acute pyelonephritis.