PERINEPHRITIS (perinephritis; Greek peri around, near + nephrite) — an inflammation of a fibrous renal capsule. Acute purulent P., by Ribbert's definition (H. Ribbert, 1940), is a microbic inflammatory process, at Krom in a fibrous renal capsule abscesses form. Perinefritichesky abscess then melts fabric of the fibrous capsule, involving an adipose capsule of a kidney in process. Such current of purulent P. comes to the end paranephritis (see). According to Salvatyerra (O. Salvatierra) and soavt. (1967), perinefritichesky abscesses are most frequent at patients of advanced and senile age. Abscesses, as a rule, unilateral and secondary by origin, owing to spread of an infection from a kidney; more rare they hematogenous origin. The activator usually are proteas and colibacillus. E. G. F. Kiister denied a possibility of an independent inflammation of a fibrous renal capsule (perinefriya); in his opinion, she is surprised for the second time, owing to transition to it inf. process from a kidney or pararenal cellulose. S. P. Fedorov, J. Izrael claim that independent defeat of a fibrous renal capsule is possible as it is the isolated anatomic education.
The fibrous renal capsule is often involved in process at a nephrolithiasis, tuberculosis, hron, pyelonephritis; in it find serous hypostasis with a productive inflammation and formation of commissures with the adipose capsule, fascial leaves surrounding a kidney with bodies. At serous P. accumulation of liquid in the fibrous capsule can reach the big sizes, leading to formation of a cyst. Pathogenetic the serous form P. can have character of the reactive subcapsular exudate connected with acute pyelonephritis or an injury of a kidney without damage of its parenchyma. A specific place is held by a fibrous and productive form P. (fibrous, fibrous and lipomatous) which quite often meets at a recurrent current of a nephrolithiasis and secondary pyelonephritis. Inflammatory process in the fibrous capsule is followed by its thickening, formation of rough commissures with a renal parenchyma and adjacent bodies and fabrics. Fibrous and productive P. which developed owing to an infection has usually progressing current. Wrinkling of the capsule is followed by disturbance of a hemodynamics and dystrophic processes in a renal parenchyma.
The clinical picture
the Disease begins with pains in lumbar and subcostal areas, temperature increase. In hypochondrium mobile education is probed, a cut can periodically decrease in sizes, but with resuming of pain increases again. Such intermittent current characteristic of serous P. is connected with a periodic resorption of exudate. Purulent P. is followed by a fever, gektichesky temperature, intoxication, a high leukocytosis. Purulent exudate collects under the fibrous capsule and, destroying it, breaks in paranefry. Fibrous and productive P. is clinically shown by a nephralgia which has constant or pristupoobrazny character; nephrogenic hypertensia is quite often observed.
At all forms P. is shown an operative measure. At serous and purulent P. make decapsulation of a kidney (see), opening and drainage of purulent cavities.
At a productive form P. make decapsulation of a kidney, removal of the fibrous capsule and the rubtso-voizmenenny fabrics restraining a kidney.
the Forecast at acute P. in case of a timely operative measure and adequate antibacterial treatment favorable. At fibrous and productive P. a recurrence of the basic renal disease and distribution of process on pararenal cellulose are possible.
See also Kidneys .
Bibliography: Babuk, To a question of a fibrous and sclerosing paranephritis, Is new. hir. arkh., t. 8, book 2, page 254, 1925; Shouting and sh V. A. Perinephritis dolorosa and its surgical treatment, XV congress of Ros-siysk. hir., page 331, Pg., 1923; To p e y Saturday of e r I. K to a question of early diagnosis of perinefrichesky abscesses, Urology, t. 5, century 3, 114, 1928; The Guide to clinical urology, under the editorship of A. Ya. Py-tel, page 382, M., 1969; Salvatierra O., B u with k 1 e w W. Century of a. Morrow J. W. Perinephric abscess, J. Urol. (Baltimore), y. 98, p. 296, 1967.
M. A. Grishin.