Renal abscess: Difference between revisions
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==Background== | ==Background== | ||
[[File:Blausen 0592 KidneyAnatomy 01.png|thumb|Renal anatomy.]] | [[File:Blausen 0592 KidneyAnatomy 01.png|thumb|Renal anatomy.]] | ||
[[File:PMC5265200 13244 2016 536 Fig1 HTML.png|thumb|Perinephric space with exaggerated pararenal space to show retroperitoneal structures. Perinephric bridging septa are seen between the left kidney and the adjacent renal fascia.]] | |||
*Rare clinical entity which can lead to delayed diagnosis | *Rare clinical entity which can lead to delayed diagnosis | ||
*Usually a complication of a [[UTI]] or [[pyelonephritis]] | *Usually a complication of a [[UTI]] or [[pyelonephritis]] | ||
**Most commonly due to [[E. Coli]], [[Klebsiella]], [[Proteus]] | **Most commonly due to [[E. Coli]], [[Klebsiella]], [[Proteus]] | ||
*Less often can be due to hematogenous spread from other sources of infection | *Less often can be due to hematogenous spread from other sources of infection | ||
**Most commonly due to Staph aureus | **Most commonly due to [[Staph aureus]] | ||
===Risk Factors=== | ===Risk Factors=== | ||
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==Evaluation== | ==Evaluation== | ||
[[File:PMC5265200 13244 2016 536 Fig11 HTML.png|thumb|CT showing a right renal abscess that has burst into the perinephric space (arrow), best appreciated as the soft tissue density interposed between the kidney and adjacent liver]]. | |||
*Labs | *Labs | ||
**CBC, BMP, [[UA]], [[lactate]] | **CBC, BMP, [[UA]], [[lactate]] | ||
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**[[Renal ultrasound]] | **[[Renal ultrasound]] | ||
***Well-defined hypoechoic lesion with thick walls and usually with internal debris | ***Well-defined hypoechoic lesion with thick walls and usually with internal debris | ||
**CT | **CT | ||
==Management== | ==Management== |
Latest revision as of 11:28, 2 May 2020
Background
- Rare clinical entity which can lead to delayed diagnosis
- Usually a complication of a UTI or pyelonephritis
- Most commonly due to E. Coli, Klebsiella, Proteus
- Less often can be due to hematogenous spread from other sources of infection
- Most commonly due to Staph aureus
Risk Factors
- Inadequately treated or delayed treatment of UTI or pyelonephritis
- Diabetes
- Renal calculi
- Ureteral obstruction
- Any underlying urinary tract abnormality
- Immunosuppression
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 |
Genitourinary infection
"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.
- Renal/perirenal
- Ureteral
- Infected urolithiasis
- Bladder
- Acute cystitis ("UTI")
- Chronic cystitis
- Urethra/periurethra
Clinical Features
- Costovertebral, flank, lumbar, lower chest, or back pain
- Usually unilateral
- Fever, especially if prolonged or after antibiotic initiation
- Nausea, vomiting
- UTI or pyelonephritis symptoms not improving with antibiotics
Complications
- Need for open surgical management or nephrectomy
- Renal failure
- Sepsis, bacteremia
- Emphysematous kidney
- Cortical abscesses can rupture and form perinephric abscesses
Differential Diagnosis
Evaluation
.
- Labs
- Imaging
- Renal ultrasound
- Well-defined hypoechoic lesion with thick walls and usually with internal debris
- CT
- Renal ultrasound
Management
- Antibiotics
- Broad spectrum if unclear source
- If urinary source cover typical urinary pathogens
- Ceftriaxone 1g IV
- Piperacillin-Tazobactam 4.5 g IV
- If hematogenous spread considered, cover for MSSA and MRSA
- Vancomycin 15-20mg/kg IV
- If urinary source cover typical urinary pathogens
- Broad spectrum if unclear source
- Percutaneous drainage
- Open surgical management if patient fails antibiotics/percutaneous drainage
Disposition
- Admission for IV antibiotics and drainage
- Especially if elderly or elevated BUN or creatinine
References
- Dembry LM, Andriole VT. “Renal and Perirenal Abscesses” Infectious Disease Clinics North America: 11, 3, (Sept 1997).
- Getting GK, Shaikh N. “Renal Abscess” Journal of EM: 31, 1 (2006): 99-100.
- Judith E, Stapczynski J. Stephan. "Urinary Tract Infections” Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011. 632.
- Yen DHT, et al. “Renal Abscess: Early Diagnosis and Treatment” Am J EM: 17, 2 (March 1999).
- Shu T, Green JM, Orihuela E. “Renal and Perirenal Abscesses in Patients with Otherwise Anatomically Normal Urinary Tracts” Journal of Urology: 172 (July 2004): 148-150.
- http://www.ncbi.nlm.nih.gov/pubmed/16798166