Difference between revisions of "Perinephric abscess"
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==Background== | ==Background== | ||
− | + | *An [[abscess]] of the perinephric fat that abuts the renal cortex | |
+ | *Can arise as a complication either a pre-existing [[pyelonephritis]] (majority) or from hematogenous seeding | ||
+ | |||
+ | ===Causative Organisms<ref>Liu XQ, et al. Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study. World Journal of Nephrology. 2016 Jan;5(1):108-14.</ref>=== | ||
+ | *[[E. coli]] (51.4%) | ||
+ | *[[S. aureus]] (10%) | ||
+ | |||
+ | {{Perinephric vs Renal Abscess}} | ||
==Clinical Features== | ==Clinical Features== | ||
*Sign/symptoms similar to [[pyelo]] ([[fever]], CVAT, dysuria) | *Sign/symptoms similar to [[pyelo]] ([[fever]], CVAT, dysuria) | ||
− | *Occurs in setting of ascending infection with obstructed pyelo | + | *Occurs in setting of ascending infection with obstructed [[pyelo]] |
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Dysuria DDX}} | {{Dysuria DDX}} | ||
− | == | + | ==Evaluation== |
− | + | ===Laboratory Testing=== | |
− | + | *CBC - Although it is a non-specific finding, a leukocytosis is typically seen. | |
− | + | *Chemistry Panel - Lactic acidosis is a common finding and is seen earlier in the disease course in diabetic patients. Renal insufficiency is also commonly seen as well. | |
− | * | + | *[[Urinalysis]] - Will often show evidence of pyelonephritis, however if the perinephric [[abscess]] is secondary to hematogenous spread, the urine could be sterile. Therefore a negative U/A does NOT rule out a perinephric abscess. |
− | + | *Blood and urine cultures | |
− | * Imaging | + | |
− | * | + | ===Imaging=== |
− | ** | + | *CT |
− | + | **Imaging modality of choice | |
− | ** | + | **Sensitivity ~90%. |
− | * | + | *Renal ultrasound - A fluid filled mass extending from the renal cortex into the perinephric fat can be seen. |
− | |||
− | |||
− | |||
− | |||
==Management== | ==Management== | ||
+ | *[[Antibiotic therapy]] depends on the suspected cause | ||
+ | **[[Pyelonephritis]] (enterobacteriaceae): third generation [[cephalosporin]] + [[quinolone]] | ||
+ | **Hematogenous ([[staphylococcus]])): [[vancomycin]] | ||
+ | **Known to be colonized by [[ESBL]]: [[carbapenem]] | ||
+ | *Abscess drainage | ||
+ | **Abscess of ANY size requires IR for percutaneous drainage | ||
+ | **If any urological obstruction is suspected ([[nephrolithiasis]], [[ureterolithiasis]], external compression from abdominal cavity, presence of pre-existing ureteral stent), emergent urological consultation should be obtained | ||
==Disposition== | ==Disposition== | ||
+ | *Admission | ||
==See Also== | ==See Also== | ||
+ | *[[pyelonephritis]] | ||
+ | *[[Emphysematous pyelonephritis]] | ||
+ | *[[Renal abscess]] | ||
+ | *[[Urolithiasis]] | ||
==External Links== | ==External Links== | ||
Line 36: | Line 51: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
− | |||
[[Category:Renal]] | [[Category:Renal]] | ||
[[Category:Urology]] | [[Category:Urology]] |
Revision as of 00:22, 21 October 2018
Contents
Background
- An abscess of the perinephric fat that abuts the renal cortex
- Can arise as a complication either a pre-existing pyelonephritis (majority) or from hematogenous seeding
Causative Organisms[1]
Perinephric vs renal abscess
Perinephric | Renal | |
Necrotic Area | perinephric fat between the renal cortex and Gerota's fascia | renal parenchyma |
Cause | Pyelonephritis (majority) | Pyelonephritis (vast majority) |
Risk of morbidity | Higher | Lower |
Clinical Features
- Sign/symptoms similar to pyelo (fever, CVAT, dysuria)
- Occurs in setting of ascending infection with obstructed pyelo
Differential Diagnosis
Dysuria
- Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
- Nephrolithiasis
- Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
- Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Uterine/bladder/vaginal prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Behavioral symptom without detectable pathology
Evaluation
Laboratory Testing
- CBC - Although it is a non-specific finding, a leukocytosis is typically seen.
- Chemistry Panel - Lactic acidosis is a common finding and is seen earlier in the disease course in diabetic patients. Renal insufficiency is also commonly seen as well.
- Urinalysis - Will often show evidence of pyelonephritis, however if the perinephric abscess is secondary to hematogenous spread, the urine could be sterile. Therefore a negative U/A does NOT rule out a perinephric abscess.
- Blood and urine cultures
Imaging
- CT
- Imaging modality of choice
- Sensitivity ~90%.
- Renal ultrasound - A fluid filled mass extending from the renal cortex into the perinephric fat can be seen.
Management
- Antibiotic therapy depends on the suspected cause
- Pyelonephritis (enterobacteriaceae): third generation cephalosporin + quinolone
- Hematogenous (staphylococcus)): vancomycin
- Known to be colonized by ESBL: carbapenem
- Abscess drainage
- Abscess of ANY size requires IR for percutaneous drainage
- If any urological obstruction is suspected (nephrolithiasis, ureterolithiasis, external compression from abdominal cavity, presence of pre-existing ureteral stent), emergent urological consultation should be obtained
Disposition
- Admission
See Also
External Links
References
- ↑ Liu XQ, et al. Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study. World Journal of Nephrology. 2016 Jan;5(1):108-14.
Authors:
Daniel Eggeman, Anthony Lucero, Claire, Neil Young, Daniel Ostermayer, Ross Donaldson