. Paranephritis (PN) – this is the inflammation of the perirenal fiber. There are primary and secondary paranephritis.Primary paranephritis it is a result of the infection in a hematogenous way from the suppurative cells or focus. It is located outside the kidney.It promotes by injury, lumbar injury, hypothermia, etc. Secondary the paranephritis occurs as a complication of the inflammatoryprocesses in the kidney. It is often localized on the left and has acute and chronic process. Classification. For localization: - bottom (the lower end) of the kidney, upper (the top end) of the kidney, front(between the kidney and the colon) - back (between the kidney and the lumbar muscles) - total (all tissue) Etiology. The primary paranephritis is often caused bygram-positive flora. The secondary process is caused by Escherichia. Coli\colon bacillus, bacteria (Rroteus, Pseudomonas). In acute paranephritis St. Aureus is often shown. The main symptoms of acute paranephritis: - high temperature; - chill; - pain in the lumbar and the hypochondrium; - tension of the abdominal muscles; - scoliosis with distortion towards the healthy kidney; - leukocytosis; - with neurogenic PN - pyuria; - with hematogenous PN - proteinuria, cylindruria, microhematuria. Types of PN: - infiltrative; - purulent; - sclerotic Pathogenesis. The process of renal tissue develops as in the next scheme: infiltrative-swelling changes - fester - cicatricial sclerosis. When the process isdragged out the manurespread towards to the lumbar region: - break under the skin in thetendon space under the 12thrib or the lumbar triangle above the crest of the ilium - swelling; - manure goes down in the femoral triangle area - flexion contracture of the hip joint. Chronic paranephritisis a result of untreated acute paranephritis. It occurs as a complication of chronic calculous pyelonephritis. Main symptoms: - Dull pain in lower back ; - Moderate rising of the temperature; - Leykograma shifts to the left; - Increase of ESR; - exacerbation of the urinary symptoms. Diagnostics. Instrumental methods. Radioscopy – reducing of the amplitude of the excursion of diaphragm on the affected side, reactive pleural effusion in the sinus on the affected side. - Plain urograms - the effaced contour of the lumbar muscles. - Excretory urography - reduced function. - Puncture around the renal substance - pus (perform the opening the abscess or the explorative lumbotomy). - Ultrasound – it is a cavity surrounded by a capsule with fluid. The treatment is conservative, if it is ineffectiveit will be operational treatment. And the acute condition of PN is conducted by subcostal retroperitoneal lymbotomia. In chronic PN – the conservative or also the operational treatment. It should be noted that the organ-saving operations is unsuitable.

1. Muhammad Nadeem Murtaza
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2.  Introduction
 Classification
 Causes
 Symptoms
 Diagnoses
 Treatment
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3. Paranephritis is a purulent-
destructive form of melting of
the pericellular tissue due to
the inflammation in the area
of the renal parenchyma. The
disease is primary or
secondary, when the
inflammatory process begins
with fiber or passes directly
from the kidneys.
Most often on the right side
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4. Depending on the localization of the
focus of inflammation, the disease is
distinguished according to the side of
the location.
oBottom ~ the lower end of kidney
oUpper ~ the top end of kidney
oFront ~ between kidney and colon
oBack ~ between the kidney and the
lumber muscles
oTotal ~ All tissues
Phases of development of pathology
o Infiltrative
o Purulent
o Sclerotic
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5. Primary Paranephritis - a result of the infection in a
hematogenous way from the suppurative cells or focus.
It is located outside the kidney. It promotes by injury,
lumbar injury, hypothermia, etc.
Secondary Paranephritis - occurs as a complication of
the inflammatory processes in the kidney. It is often
localized on the left and has acute and chronic process.
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6. occurs in various forms and localizations, most often on the right side
Inflammation begins to develop from the lymph nodes, the anterior and
posterior renal surfaces.
Chronic Form
• Chronic parainfrain is formed as a result of calculous and
tuberculous pionephrosis
• long infiltrating inflammatory process in the kidney fatty tissue
• a gradual fibrous degeneration of the tissues is observed
• is a secondary inflammatory process that does not occur on its own.
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7. Acute Form
• develops in various kidney diseases,
odue to primary or secondary inflammation
ohematogenous infiltration of the infection( with abscess or carbuncle of
the kidney) in peritoneal cellulose
oMost often after Surgery and Trauma
• Is a serous and purulent form
• Well treatable
• Elimination of inflammation can stop further complications
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8. Primary Paranephritis is often caused by gram-positive
flora.
Secondary Paranephritis is caused by Escherichia.
Colicolon bacillus, bacteria (Rroteus, Pseudomonas). In
acute paranephritis St. Aureus is often shown.
Pyelonephritis – penetration of pathogenic flora through
the lymphogenous, hematogenic and urinary tract.
Stabbing Injury of Kidney – infection in the wound canal
spread quickly enough to reach the pericardial tissues
and provoke the development of purulent inflammation.
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9. Paranephritis can also spread from the tissues of internal organs
located in the abdominal cavity and small pelvis. Primarily, the
cause of inflammation is the descending or ascending colon.
The most frequent foci of infection, due to which infection
occurs:
• Cholecystitis
• Cystitis
• Tonsillitis
• Sinusitis
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10. Excessive fatigue, weakness, and tension of the abdominal
muscles
Shortness of breath (when walking and at rest)
Abrupt weight loss (for no apparent reason)
Sleep disturbance
Pain in the lower back (lumber region)
Increase in temperature (during the height of the illness)
Decrease in daily excretion of urine
Increase of ESR (In Chronic Form) 2 3 / 0 1 / 2 0 2 3
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11. Turbid (cloudy) Urine ~ When urine upheld, separation of three
layers (Renal Detritus, Purulent Sediment, and Urine) can be
seen.
Scoliosis with distortion towards the healthy kidney
Leukocytosis
• With neurogenic PN
Pyuria;
• With hematogenous PN
Proteinuria, Cylindruria,
Microhematuria
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12. Symptoms of paranephritis can not fully serve as evidence of inflammation.
For further confirmation:
X-Ray ~ to determine the limitation of movement of in the region of
inflammatory focus
• reducing of the amplitude of the excursion of diaphragm on the affected side,
• reactive pleural effusion in the sinus on the affected side.
Emergency urography ~ performed on exhalation and inhalation.
Puncture around the renal substance ~ pus (perform the opening the
or the explorative lumbotomy
Ultrasound ~ to see cavity surrounded by a capsule with fluid
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13. Early treatment can be Conservative, but Drug Therapy does not have
pronounced effect
For quick result ~ Surgical procedure in the form of Abscess Drainage
procedure is prescribed (Skin over the area of inflammation is opened and
pus is extracted)
In the case of inflammation of kidney, treatment is Autopsy (complete
removal of organ), procedure last for 1-3 hours (depending upon the
volumes of abscesses)
After autopsy
• Patient remains in hospital for observation
• Receive antibiotic therapy (Carbapenems and Fluoroquinolones) for whole
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