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Renal Abscess


Presentation

  • Fever, loin pain, and leukocytosis were common presenting features, but less than half of all abscesses were associated with either an abnormal urinalysis or a positive urine culture.[ncbi.nlm.nih.gov]
  • A case of renal abscess caused by an unusual Salmonella serotype is presented in which the clinical presentation was suggestive of renal neoplasia.[ncbi.nlm.nih.gov]
  • Abstract Renal abscesses are uncommon in children, and usually present with a high fever and flank pain. We report a 9-year-old girl who presented with abdominal pain and cough.[ncbi.nlm.nih.gov]
  • Early imaging of the kidney in unresolved renal infection is essential if renal abscess, its delayed presentation and complications are to be avoided.[ncbi.nlm.nih.gov]
  • We present a peritoneal dialysis (PD) patient who had a renal biopsy performed during an episode of urosepsis and subsequently presented with a renal abscess at the biopsy site along with concurrent peritonitis.[ncbi.nlm.nih.gov]
Fever
  • Renal abscess is uncommon in pediatrics and is rarely a cause of fever of unknown origin. We recently cared for a patient who presented with a 3-week history of fever. An indium scan ultimately led to the diagnosis of a renal abscess.[ncbi.nlm.nih.gov]
  • Classic enteric fever is caused by S. typhi and usually less severe enteric fevers are caused by S. paratyphi A, B, or C.[ncbi.nlm.nih.gov]
  • A 14-year-old girl with acute lymphocytic leukemia complained of right flank pain and fever. As her fever was prolonged, she underwent renal biopsy and was diagnosed with mucormycosis.[ncbi.nlm.nih.gov]
  • The first patient was a nine-year old girl with a three-week history of intermittent fever and the second was a three-year old boy with a four-day history of fever. Pseudomonas aeruginosa was isolated from the urine cultures of both children.[ncbi.nlm.nih.gov]
  • Renal abscesses must be suspected in children with loin pain, fever and leukocytosis. They may heal even without hospitalization and drainage.[ncbi.nlm.nih.gov]
High Fever
  • Abstract Renal abscesses are uncommon in children, and usually present with a high fever and flank pain. We report a 9-year-old girl who presented with abdominal pain and cough.[ncbi.nlm.nih.gov]
  • We report on a 7-month-old female infant who was hospitalized with a high fever. Ultrasonography revealed a hypoechogenic mass in the left kidney. The diagnosis of a renal abscess was confirmed by computed tomography.[ncbi.nlm.nih.gov]
  • It shows a tumoral radiological pattern; in the context of clinical signs of suppuration (high fever, high leucocyte count and variably a urinary tract infection). The radiological findings suggest the diagnosis of abscess.[ncbi.nlm.nih.gov]
  • A 45-year-old Chinese man presented with a high fever, urine occult blood, and a low density lesion in the right kidney. Ultrasound-guided aspiration was done. Brucella melitensis was isolated from both blood and puncture fluid culture.[ncbi.nlm.nih.gov]
  • Most often they presented with high fever and flank pain. USG and CT were used to establish the diagnosis. Urine culture yielded organisms in five cases and hence empirical antibiotic therapy for Gram-negative organism was offered.[ncbi.nlm.nih.gov]
Malaise
  • Nonspecific constitutional symptoms (eg, malaise, fatigue, weight loss) may occur in patients with xanthogranulomatous pyelonephritis (XGP).[emedicine.medscape.com]
  • Signs and Symptoms of a Renal Abscess Fever and chills Flank pain or abdominal pain Weight loss, malaise Urosepsis Kidney Abscess: Diagnostic Work-Up Urine culture: Urine culture can often isolate the responsible bacteria and is needed for antibiotic[urology-textbook.com]
  • Other symptoms are nausea, malaise and weight loss . Psoas muscle abscess may be classified as primary or secondary depending on the presence or absence of underlying disease.[radiopaedia.org]
  • Most patients with this histopathological nature of pyelonephritis initially present with non-specific features such as fever of unknown origin, anorexia, nausea, weight loss, malaise and constipation, typically delaying the diagnosis by three months[jmedicalcasereports.biomedcentral.com]
  • Malaise, nausea, vomiting, anorexia and occasionally diarrhoea occur. There may or may not be accompanying lower urinary tract symptoms with frequency, dysuria, gross haematuria or hesitancy.[patient.info]
Recurrent Urinary Tract Infection
  • We report a 15-year-old girl with a history of recurrent urinary tract infections who developed a right renal abscess. Percutaneous abscess drainage and subsequent microbiological culture revealed CA-ESBL Escherichia coli.[ncbi.nlm.nih.gov]
  • Most patients with renal corticomedullary abscess have a history of recurrent urinary tract infections, renal calculi, and/or prior genitourinary tract instrumentation. Urinary tract obstruction is an important predisposing factor.[emedicine.medscape.com]
  • "Antibiotics for recurrent urinary tract infections". American Family Physician. 71 (7): 1301–2. PMID 15832532. Williams, GJ; Craig, JC (2011). Williams, Gabrielle (ed.).[en.wikipedia.org]
Flank Mass
  • Abstract Renal abscess is rare in children and the usual presenting features include fever, lumbar pain, abdominal pain and occasional flank mass. Renal ultrasonography facilitates an early diagnosis and helps in percutaneous drainage.[ncbi.nlm.nih.gov]
  • Fever, lumbar pain, abdominal pain and occasional flank mass are the usual presenting complaints but a high degree of suspicion is important for the early detection of renal abscess.[kjp.or.kr]
  • The common manifestations include fever, lumbar pain, abdominal pain and occasional flank mass. Renal ultrasonography enables us to achieve an early diagnosis, however; it may still be insufficient to distinguish it from pyelonephritis.[pediatricurologycasereports.com]
Aspiration
  • Renal abscess was diagnosed by percutaneous needle aspiration under computerized tomography guidance. The patient was treated with parenteral antibiotics and percutaneous aspiration of the abscess.[ncbi.nlm.nih.gov]
  • It is possible to cure renal brucelloma with antibiotics and ultrasound-guided aspiration. Treatment should not be discontinued until the abscess has disappeared and two consecutive blood cultures taken 1 month apart are negative.[ncbi.nlm.nih.gov]
  • An In-111 leukocyte scan failed to detect the right renal abscess, which later was aspirated under CT guidance and explored surgically.[ncbi.nlm.nih.gov]
  • We report a case in which percutaneous aspiration of a renal abscess led to successful non-operative management. In addition, 4 previously reported cases of renal abscesses treated with this modality are analyzed.[ncbi.nlm.nih.gov]
  • Using percutaneous aspiration, we were able to establish the correct diagnosis and identify the causative micro-organism. The patient was successfully treated with a combined intravenous and oral course of antibiotics.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Abstract Renal abscess is rare in children and the usual presenting features include fever, lumbar pain, abdominal pain and occasional flank mass. Renal ultrasonography facilitates an early diagnosis and helps in percutaneous drainage.[ncbi.nlm.nih.gov]
  • We report a 9-year-old girl who presented with abdominal pain and cough.[ncbi.nlm.nih.gov]
  • The patient presented with abdominal pain and mild fever for three months and the diagnosis was made by X-ray in the kidney, ureter and bladder (KUB) region, intravenous pyelography and ultrasonography of the abdomen.[ncbi.nlm.nih.gov]
  • Fever and abdominal pain were the most common clinical symptoms. A premorbid genitourinary condition was present in 310/a of patients. Previous urinary tract infection was documented in 31% of the cases.[ncbi.nlm.nih.gov]
  • We concluded that the renal abscesses must be assumed, especially, in children with prolonged fever, abdominal pain, and a high value of CRP.[ncbi.nlm.nih.gov]
Hypertension
  • Renal scarring may lead to hypertension, renal insufficiency and potential failure.[pediatriceducation.org]
  • Secondary hypertension. Pyonephrosis. Focal glomerulosclerosis. Urea-splitting organisms can lead to staghorn calculi - the usual culprit is Proteus spp.[patient.info]
Eye Pain
  • Endophthalmitis presented with visual loss, conjunctiva injection and lid edema with eye pain. Right costovertebral knocking pain was also noted.[ncbi.nlm.nih.gov]
Night Sweats
  • He had intermittent high fevers to 103 F, along with chills and night sweats for 7 days. Upper respiratory symptoms, including nasal congestion and cough, were noted for a few days.[healio.com]
Meningism
  • However, at times S. paratyphi is capable of causing serious and often life-threatening infections like infective endocarditis, pericarditis, empyma, sino-venous thrombosis, osteomyelitis, meningitis, bone marrow infiltration, hepatitis and pancreatitis[ncbi.nlm.nih.gov]
  • Considering the cases reported in the literature, this commensal yeast has been involved in fongaemia, peritonitis, meningitis, endocarditis, conjonctiva infection, etc…).[aspergillus.org.uk]
  • S. typhi has been reported to cause the life-threatening infections such as meningitis, endocarditis, myocarditis, empyema, and hepatic abscess. Renal involvement by S. typhi is a relatively rare presentation.[jlponline.org]
Flank Pain
  • A 14-year-old girl with acute lymphocytic leukemia complained of right flank pain and fever. As her fever was prolonged, she underwent renal biopsy and was diagnosed with mucormycosis.[ncbi.nlm.nih.gov]
  • We present a case of renal abscess for Aspergillus fumigatus in a patient with acquired immunodeficiency syndrome who complained of flank pain and fever.[ncbi.nlm.nih.gov]
  • Abstract Renal abscesses are uncommon in children, and usually present with a high fever and flank pain. We report a 9-year-old girl who presented with abdominal pain and cough.[ncbi.nlm.nih.gov]
  • All presented with flank pain and fever. Urine and blood cultures were sterile. The diagnosis was made using ultrasound and computerized axial tomography.[ncbi.nlm.nih.gov]
  • Flank pain and fever had a sudden onset. The diagnosis was made in the first case by ultrasound and gadolinium-enhnaced magnetic resonance, in the second case ultrasound and computerized axial tomography were used.[ncbi.nlm.nih.gov]
Dysuria
  • Risk factors The predisposing factors include 4 : diabetes mellitus renal calculi ureteral obstruction The most common signs or symptoms are : fever flank/abdominal pain chills dysuria Ultrasound Typically, a renal abscess appears as a well-defined hypoechoic[radiopaedia.org]
  • Symptoms of UTI (dysuria, frequency) are not common manifestations of both types of abscesses. Choice of antibiotic therapy is generally targeted towards gram negative coverage (unless concern for hematogenous spread of staphylococcus is high).[ucsfmed.wordpress.com]
  • Patients with renal abscesses may present with clinical pyelonephritis symptoms such as fever, nausea, weight loss, dysuria, malodorous urine, abdominal or flank pain.[pediatriceducation.org]
  • Some individuals with renal corticomedullary abscess develop dysuria and other urinary tract symptoms. Nonspecific constitutional symptoms (eg, malaise, fatigue, weight loss) may occur in patients with xanthogranulomatous pyelonephritis (XGP).[emedicine.medscape.com]
  • The main symptoms are following: Abdominal pain Fever Chills Dysuria If this abscess rupture, it causes renal atrophy or renal obstruction.this disease can be cured by surgical removal or by using antibiotics.this disease can be investigated by ultrasound[curerator.com]
Hematuria
  • Symptoms of Cystitis are chief complaint - A strong, persistent urge to urinate -A burning sensation when urinating -Passing frequent, small amounts of urine -Blood in the urine (hematuria) -Passing cloudy or strong-smelling urine -Discomfort in the pelvic[quizlet.com]
  • Today we discussed the case of a young man presenting with RLQ/flank pain and hematuria, found on imaging to have a renal abscess vs mass! We had an interesting discussion on renal vs perinephric abscesses.[ucsfmed.wordpress.com]
  • Moreover, the blood cultures yielded Escherichia coli and hematuria without pyuria were noted.[ijcasereportsandimages.com]
  • […] older than 50 years • Underlying condition compromising immune system: Diabetes, immunosuppression, chronic debilitating disease • Symptoms of urinary tract infection Fever, irritative voiding symptoms, flank pain • Symptoms of bladder irritability & hematuria[slideshare.net]
  • Urinalysis – positive for signs of pyuria which include nitrites and leukocyte esterase, can be positive for hematuria (nitrites are only present when infections are caused by the Enterobacteriaceae).[clinicaladvisor.com]

Workup

  • This workup should include preoperative imaging to define the extent of the parenchymal process (see Imaging Studies).[emedicine.medscape.com]
  • Initial ED diagnostic workup included a hemogram that showed marked leukocytosis with neutrophilia (WBC: 36,100/mm 3 and ANC: 20,700/mm 3 ) and normocytic, hypochromic anemia (hemoglobin 9.1 g/dL, MCV 64 and MCH 21).[healio.com]
Nephrolithiasis
  • Flank Pain… Flank pain for several days, history of nephrolithiasis: This patient has marked right hydronephrosis with significant right renal perinephric inflammatory cystic changes extending into the contiguous right psoas musculature and right retroperitoneum[emrems.com]
  • Ascending urinary tract infections (pyelonephritis), tubular obstruction and nephrolithiasis are common risk factors for a renal abscess. Perinephric abscess may result from the rupture of a renal abscess with cortical location.[urology-textbook.com]
  • Management of lower pole nephrolithiasis: A critical analysis. J Urol 1994 Mar;151(3):663–7. [ Pubmed ] Goldberg S, Coyne D. Renal diseases: Nephrolithiasis. In: HemantGodara, eds. The Washington Manual of Medical Therapeutics, 34RD edition.[ijcasereportsandimages.com]
  • Right hydronephrosis grade III with multiple right nephrolithiasis were also observed.[ncbi.nlm.nih.gov]
  • Obstruction – nephrolithiasis, increased post void residual, neurogenic bladder 2. Immunosuppression – diabetes, renal transplant, steroid use 3. Metabolic – nephrolithiasis 4.[clinicaladvisor.com]
Multiple Pulmonary Nodules
  • We report the case of a 46-year-old woman with acute febrile symptom who had multiple pulmonary nodules and a renal mass.[ncbi.nlm.nih.gov]
Pyuria
  • Purulent urine, pyuria, bacteriuria, and bacteremia were noted after admission. Renal abscess was diagnosed by percutaneous needle aspiration under computerized tomography guidance.[ncbi.nlm.nih.gov]
  • Fever, chills and flank pain were the most common symptoms and signs, whereas pyuria, elevation of leukocyte count, glucose, blood urea nitrogen and creatinine were the common laboratory features.[ncbi.nlm.nih.gov]
  • ., fever (average 101F), flank or abdominal pain and pyuria. No patient had evidence of septic shock at hospitalization. Escherichia coli was the documented organism in each case.[ncbi.nlm.nih.gov]
  • Pyuria (pus in urine) 4. Progressive renal failure 5. Pain due to ureteral colic 6.[quizlet.com]
  • Moreover, the blood cultures yielded Escherichia coli and hematuria without pyuria were noted.[ijcasereportsandimages.com]
Citrobacter Koseri
  • We present a rare case of endogenous endophthalmitis caused by Citrobacter koseri. A 69-year-old woman with a history of poorly controlled diabetes and a protracted urinary tract infection (UTI) presented with a painful swollen left eye.[ncbi.nlm.nih.gov]
Blood Culture Positive
  • Laboratory tests: Blood culture (positive in 50%). Blood count, coagulation tests ( PTT, PT ), CRP, liver enzymes, creatinine. In suspected urosepsis, determination of sepsis parameters such as blood gas testing, AT III and fibrinogen.[urology-textbook.com]

Treatment

  • A treatment algorithm is reported.[ncbi.nlm.nih.gov]
  • Selective arterial embolization is an effective and safe treatment of large angiomyolipomas with low complication rates. Percutaneous drainage was the recommended treatment for renal abscess formation following the embolization.[ncbi.nlm.nih.gov]
  • In addition, during the period of treatment, a series of sonography were performed to monitor resolution of abscess.[ncbi.nlm.nih.gov]
  • On treatment the rapid regression and disappearance of the various clinical, laboratory, and radiological findings confirms the diagnosis of renal abscess.[ncbi.nlm.nih.gov]
  • The patient had a good response to the established treatment and he remains in a good clinical condition at one year of follow up.[ncbi.nlm.nih.gov]

Prognosis

  • The purpose of this study is to demonstrate the clinical characteristics of K pneumoniae renal abscess for early diagnosis and to identify the clinical risk factors associating with poor prognosis.[ncbi.nlm.nih.gov]
  • Clinical factors were also analyzed for their value in predicting poor prognosis. The mean age of 88 patients with renal abscess was 59.8 years.[tmu.pure.elsevier.com]
  • Poor prognosis is associated with elderly patients with lethargy and with elevation of the serum blood urea nitrogen level.[ncbi.nlm.nih.gov]
  • Prognosis is often guarded despite appropriate treatment. Based on the results of this study we propose a management algorithm.[ncbi.nlm.nih.gov]
  • (Outcomes/Resolutions) In most cases, an immediate diagnosis and suitable treatment of Perirenal Abscess will result in good prognosis Any case of kidney stones must be treated promptly, because it is the biggest risk factor that may lead to Perirenal[dovemed.com]

Etiology

  • The possible etiology of acute focal bacterial nephritis, its evolution to abscess formation and its distinguishing features are discussed.[ncbi.nlm.nih.gov]
  • Abstract Archives of the RSNA, 2013 Victor Javier Casillas MD, Presenter: Nothing to Disclose 1) To descrbe the clinical presentation, etiology and radiographic imaging modalities to evaluate acute pyelonephritis and renal abscess. 2) To illustrate the[archive.rsna.org]
  • In addition, various host factors influence the development and severity of renal infection (see Overview/Etiology ).[emedicine.medscape.com]
  • Etiology of Renal Abscess Gram-negative Bacteria: A renal abscess is most common caused by gram-negative bacteria such as E. coli and Proteus.[urology-textbook.com]
  • (Etiology) Perirenal Abscess is an infectious formation that may be caused by microorganisms such as: Escherichia coli, Proteus species, and Staphylococcus aureus are the typical organisms that cause the condition Gram-negative bacteria, such as Klebsiella[dovemed.com]

Epidemiology

  • The CT findings of renal abscesses and neoplasm are discussed as well as a brief discussion on the epidemiology of Salmonella infections.[ncbi.nlm.nih.gov]
  • MATERIALS AND METHODS: We retrospectively reviewed charts regarding discharge diagnoses, radiological studies, pathological specimens, epidemiology factors and outcomes. Statistical analysis was performed using loglinear and covariant analysis.[ncbi.nlm.nih.gov]
  • "Population-based epidemiologic analysis of acute pyelonephritis" (PDF). Clin Infect Dis. 45 (3): 273–80. doi : 10.1086/519268. PMID 17599303. Archived (PDF) from the original on 2013-12-28. Goodman, TR; McHugh K; Lindsell DR (1998).[en.wikipedia.org]
  • Epidemiology There are few data available.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • In a few cases, ascending infection and/or hematogenous spread have been outlined as pathophysiologic mechanisms in published studies. We report on a 7-month-old female infant who was hospitalized with a high fever.[ncbi.nlm.nih.gov]
  • The pathophysiology of renal abscesses has changed during the past 25 years. Most cases are now caused by gram negative enteric organisms that are similarly pathogenic in uncomplicated cystitis and pyelonephritis.[ncbi.nlm.nih.gov]

Prevention

  • Usually, the flank position is preferred because of ease of establishing a drainage tract and prevention of possible peritoneal exposure to infected material.[emedicine.medscape.com]
  • Seite 290 - Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis. Hepatology 1999; 29: 1655-61 6. ‎[books.google.de]
  • Health care services aimed at preventing health problems or maintaining health are provided. Medical Knowledge 10. An investigatory and analytic thinking approach to the clinical situation is demonstrated. 11.[pediatriceducation.org]
  • Prevention On the assumption that most pyelonephritis is caused by ascending infection, its prevention is based on preventing UTI. If children have structural abnormalities of the renal tract they require assessment with a view to correction.[patient.info]

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