1. Chills,

2. fever low grade

3. unilateral flank pain,

4. Abdominal pain

5. Malaise and prostration

6. Dysuria

7. Tenderness over the affected kidney and costovertebral angle.

8. Large mass may be felt or percussed in the flank.

9. Erythema and edema of the overlying skin may be evident

Question: what is the principle of diagnosis of perinephric abscess?

1. CBC: leukocytosis, high ESR

2. Urinalysis: pyuria and bacteriuria

3. Positive blood cultures may be observed

4. serum creatinine and blood urea nitrogen values generally are normal unless both kidneys are involved

5. plain abdominal X-ray: shows flank mass

6. excretory urography (done on inspiration and expiration): Limitation or absence of mobility of kidney (classic sign), may show delayed visualization or nonfunction related to obstructive uropathy or parenchymal disease.

In case of paranephric abscess the main sign is Limitation of diaphragm excursions on the side of lesion

Question: what is the principle of perinephric abscess and paranephric abscess treatment?

Perinephric abscess treatment:

1. percutaneous nephrostomy

2. Intravenous antibiotics

Operative treatment for paranephric abscess:

1. Lumbotomy, opening of perinephric abscess with its drainage

2. Intravenous antibiotics

Question: what is the etiology of tuberculosis of urinary tract?

Bacteria (Mycobacterium tuberculosis)

Question: what is the classification of urinary tract tuberculosis with the help of X-ray, clinical findings?

1. I — nondestructive (infiltrate) tuberculosis of kidney;

2. II — initial destruction (papillitis or small, by diameter about 1 cm, single cavity);

3. III —marked destruction (caverns or policavernosial tuberculosis one of kidney segments);

4. IV — total or subtotal destruction (policavernose tuberculosis of two segments, tubercular pyonephrosis, calcification kidney).

Three forms of tuberculosis:

1. tuberculoinfiltrative,

2. ulcerous and

3. scar

Question: what are the signs and symptoms of tuberculosis of the urinary tract?

1. low-grade but persistent fever,

2. night sweats

3. Symptoms of cystitis (dysuria, hematuria, urine urgency etc.)

4. Hematuria

5. Evidence of extragenital tuberculosis may be found (lungs, bone, lymph nodes, tonsils, intestines)

Question: what is the diagnosis of kidney's tuberculosis?

1. CBC: leukocytosis, high ESR

2. Urinalysis: pyuria, ‘’sterile ‘’ pyuria (no microbes detected in urine)

3. Blood culture positive for mycobacterium tuberculosis

4. Positive tuberculin test (Mantoux test): skin induration more than 5mm

5. Cystoscopy: intravesical signs are;

1. Yellow raised nodules (Tubercles) surrounded by a halo of hyperemia

2. ulcer,

3. microcyst,

4. gaping and pulled in ureteral openings ("golf-hole" (gaping) ureteral orifice)

6. abdominal X-ray:

1. enlargement of one kidney

2. Obliteration of the renal and psoas shadows due to perinephric abscess.

3. Punctate calcification in the renal parenchyma

7. Excretory urography

1. distortion of calyx,

2. ureteral dilation above a UVJ stricture or a rigid fibrotic ureter with multiple strictures

3. Small and contracted urinary bladder (thimble bladder) or with filling defects.

8. CT scan

1. calyceal abnormalities,

2. hydronephrosis

3. urinary tract calcifications, and renal parenchymal cavities

Question: what is the treatment of tuberculosis of the urinary tract?

1. Medical treatment:

1. Antituberculosis agents for 6months:

First 2months: rifampicin 600 mg, isoniazid 300 mg, pyrazinamide 1 g, 1 g of vitamin C daily for 2months

4months: 900 mg of rifampin, 1.5 g of pyrazinamide, and 1 g of vitamin C twice a week for 4 months.

2. If, after 3 months, cultures are still positive and gross involvement of the affected kidney is radiologically evident, nephrectomy should be considered.

3. If bacteriologic and radiographic studies demonstrate bilateral disease, only medical treatment can be considered

2. Surgical treatment:

1. Nephrectomy

2. Operation of Boari: Plastic of the deformed ureter with wall of urinary bladder.