Synonyms
urinary intoxication, bacteremia, sepsis
Definition
In urosepsis there is a transfer of toxin-forming germs from the kidney into the bloodstream (blood poisoning). Pathogens are mainly E. coli (>50%), as well as Klebsiella, Proteus or Enterobacter. Urinary poisoning
Causes
Risk factors for the development of urosepsis are urinary flow disorders, a drug therapy suppressing the immune system (e.g. chemotherapy), an operation instead of surgery (e.g. with the use of permanent catheters) with carry-over of highly antibiotic-resistant germs, diabetes mellitus, malignant tumors or liver cirrhosis at the bottom of a renal pelvic inflammation.
- Kidney Marrow
- Cortex of the kidney
- Renal artery
- Renal Vein
- Ureter (Ureter)
- Kidney capsule
- Renal calyx
- Renal pelvis
Symptoms
They are similar to those of septic shock (shock caused by blood poisoning). In the initial stage the skin is warm, only later, due to constriction of vessels far from the heart, cold acra (fingertips, toes, nose) and bluish (livid) discoloration appear. Caution is advised with: If these symptoms occur, there is an acutely life-threatening condition.
- Fever with chills
- Tachycardia (high pulse rate)
- Blood pressure drop
- Tachypnea (high breathing rate)
- Clouding of consciousness
- As well as lack of urinary excretion (oliguria to anuria).
Diagnosis
Top priority is given to the search for the cause (urinary stasis?, renal abscess?) by means of ultrasound. The pathogens should be identified as quickly as possible using blood and urine cultures, also to detect any resistance to antibiotics. The presence of the pathogen in the blood should be detected:
- Initially high number of white blood cells (leukocytosis), then very low number (leukocytopenia)
- Decrease of the coagulation parameters (platelets, Quick – value)
- Anaemia
- Acid – bases – household derailed
Therapy
If an inflamed and congested kidney is present, it must be relieved immediately. This is done by means of a ureteral splint or renal fistula (nephrostomy). In the case of a renal fistula, the urine is artificially drained to the outside via a tube that is placed in the renal pelvis.
This is followed by a broad antibiotic therapy, usually using a combination of aminoglycosides and penicillins or cephalosporins. The circulation is stabilized, e.g. by water-binding infusion solutions (plasma expanders), which replenish the lost blood volume. Infusion therapy should be initiated to balance the fluid balance and promote urination.
The derailment of the acid – base balance can be neutralized by the administration of bicarbonate. Under certain circumstances, coagulation factors may have to be replaced or even hemofiltration (toxins are filtered out of the blood) may be necessary. The most important measure is the removal of the original source of coagulation. In the worst case, removal of the kidney can be life-saving.
