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Watercolour drawing of a dissected kidney, showing a condition of acute pyonephrosis. The ureter is blocked by a calculus and several calculi are seen lying in the sacculi.
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Pyonephrosis (Greek pyon "pus" + nephros "kidney")[1] is a dangerous kidney infection that is characterized by pus accumulation in the renal collecting system.[2] It is linked to renal collecting system blockage and suppurative renal parenchymal destruction, which result in complete or nearly complete kidney failure.[3]

Signs and symptoms[edit]

Clinical symptoms in patients with pyonephrosis can range from frank sepsis (15%) to asymptomatic bacteriuria. Upon physical examination, the hydronephrotic kidney may be linked to a palpable abdominal mass.[4] On rare occasions, the hydronephrotic kidney infection may burst spontaneously into the peritoneal cavity, resulting in diffuse peritonitis and sepsis in certain patients.[5]


Pyonephrosis can result from an upper urinary tract infection combined with blockage and hydronephrosis.[4]


When a patient has suspected pyonephrosis, the initial workup should consist of a complete blood count, serum chemistry with blood urea nitrogen (BUN) and creatinine, blood cultures, and urinalysis with culture[6]

It is generally not recommended to perform routine radiographic imaging on patients who have simple Urinary tract infections. When patients do not improve quickly with appropriate antibiotics, however, appropriate radiographic studies help diagnose pyonephrosis, emphysematous pyelonephritis, and renal and/or perirenal abscesses.[7]


Together with intravenous antibiotics, drainage[8]—either percutaneous or retrograde with a ureteral stent[9]—has become the cornerstone of treatment since the development of ultrasonography and computed tomography (CT) scanning. Drainage offers a great outcome with low rates of morbidity and mortality. A CT scan or ultrasound-guided drainage greatly reduces the need for a nephrectomy.[4]

See also[edit]


  1. ^ "pyonephrosis" at Dorland's Medical Dictionary
  2. ^ Kumar, Lanka Praveen; Khan, Irshad; Kishore, Amit; Gopal, Manoj; Behera, Vineet (July 1, 2016). "Pyonephrosis among Patients with Pyelonephritis Admitted in Department of Nephrology and Urology of a Tertiary Care Centre: A Descriptive Cross-sectional Study". Journal of Nepal Medical Association. 61 (258). Nepal Medical Association: 111–114. doi:10.31729/jnma.8015. PMC 10088997. PMID 37203981.
  3. ^ Scârneciu, Ioan; Constantina, Alexandru; Grigorescu, Dan; Maxim, Laurian (2015). "Pyonephrosis: diagnosis and treatment: report of 65 cases". Jurnal Medical Brasovean: 45–48. ISSN 2247-4706. Retrieved December 28, 2023.
  4. ^ a b c Peterson, Andrew C (December 14, 2023). "Pyonephrosis: Practice Essentials, Etiology, Prognosis". Retrieved December 28, 2023.
  5. ^ Quaresima, Silvia; Manzelli, Antonio; Ricciardi, Edoardo; Petrou, Athanasios; Brennan, Nicholas; Mauriello, Alessandro; Rossi, Piero (2011). "Spontaneous intraperitoneal rupture of pyonephrosis in a patient with unknown kidney carcinosarcoma: a case report". World Journal of Surgical Oncology. 9. BMC: 39. doi:10.1186/1477-7819-9-39. PMC 3087700. PMID 21486444.
  6. ^ M, St Lezin; R, Hofmann; ML, Stoller (1992). "Pyonephrosis: diagnosis and treatment". British Journal of Urology. 70 (4). Br J Urol: 360–363. doi:10.1111/j.1464-410x.1992.tb15788.x. ISSN 0007-1331. PMID 1450841. Retrieved December 28, 2023.
  7. ^ DA, Baumgarten; BR, Baumgartner (1997). "Imaging and radiologic management of upper urinary tract infections". The Urologic Clinics of North America. 24 (3). Urol Clin North Am: 545–569. doi:10.1016/s0094-0143(05)70401-8. ISSN 0094-0143. PMID 9275978. Retrieved December 28, 2023.
  8. ^ S, Ramsey; A, Robertson; MJ, Ablett; RN, Meddings; GW, Hollins; B, Little (2010). "Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi". Journal of Endourology. 24 (2). J Endourol: 185–189. doi:10.1089/end.2009.0361. ISSN 1557-900X. PMID 20063999. Retrieved December 28, 2023.
  9. ^ ZL, Barbaric; T, Hall; ST, Cochran; DR, Heitz; RA, Schwartz; RM, Krasny; MW, Deseran (1997). "Percutaneous nephrostomy: placement under CT and fluoroscopy guidance". AJR. American Journal of Roentgenology. 169 (1). AJR Am J Roentgenol: 151–155. doi:10.2214/ajr.169.1.9207516. ISSN 0361-803X. PMID 9207516. Retrieved December 28, 2023.

Further reading[edit]

External links[edit]