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renal_abscess

renal abscesses and perinephric abscesses

introduction

  • renal abscesses and perinephric abscesses generally present as flank pain with fever and markedly raised inflammatory markers such as C reactive protein (CRP)
  • they may present insidiously, particularly in the elderly, diabetcis or chronic alcoholism who may have autonomic neuropathy
  • the urine culture may be NAD if it is haematogenous spread of infection instead of the more usual ascending UTI aetiology
  • haematogenous spread abscesses are primarily perinephric or arise in the cortex of the kidney (not the medulla)
  • perinephric abscesses occur in the space confined by Gerota's fascia
    • these may spread into:
      • the retroperitoneum
      • the collecting system of the kidney
      • the flank muscles
      • the psoas muscle
      • the groin
      • the paravesicle region
      • the peritoneum (uncommmon)
      • the subdiaphragmatic region to for a subphrenic abscess and then even into the thoracic cavity to form an empyema or even a nephrobronchial fistula
      • the colon
  • diagnosis is generally made by the finding of a mass in the kidney or near the kidney (perinephric) on CT KUB scan, however, a contrast CT scan is preferable.

DDx of perinephric abscess

DDx of renal abscess

  • acute lobar nephronia
    • focal region of interstitial nephritis causing a renal mass which is an intermediate state between acute acute pyelonephritis and renal abscess
  • malakoplakia - inflammatory reaction due to E.coli infection

Mx in ED

  • assumes a mass has been detected on CT scan
  • urgent referral to urology
    • early percutaneous drainage and culture is generally indicated for:
      • renal abscesses > 5cm
      • all perinephric abscesses
      • for cases not responding to antibiotics
      • severe sepsis
  • for perinephric abscesses:
    • if prompt drainage is feasible, ideally drainage should be performed prior to initiation of antimicrobial therapy, so that Gram stain and culture results can be used to guide selection of therapy
    • empiric antibiotic Rx of cases with presumed haematogenous cause should cover Staph. aureus
  • if unwell, manage as per sepsis / septicaemia with early iv antibiotic and iv fluid resuscitation
  • percutaneous drainage has decreased morbidity compared with surgical drainage
renal_abscess.txt · Last modified: 2018/03/27 01:10 by 127.0.0.1

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