Renal and Perinephric Abscesses Revisited

Rai, RS; Karan, S.C.; Kayastha, Anuj

doi:10.1016/s0377-1237(07)80139-0

Cited by 20 publications

(26 citation statements)

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“…The classic open surgical drainage for perinephric abscess has been challenged by the introduction of image guided percutaneous tube drainage methods and antibiotics alone (12). The general consensus is that large abscesses and patients with predisposing factors require drainage in addition to antibiotics (12,13).…”

Section: Commentsmentioning

confidence: 99%

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What is the best drainage method for a perinephric abscess?

et al. 2010

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Purpose:To compare the results of percutaneous and open drainage for perinephric abscess. Materials and Methods:The files of 86 patients who underwent drainage for perinephric abscesses from April 2001 through March 2008 were evaluated. The method of drainage for each patient was performed according to the clinical decision of the treating physician. Percutaneous tube drain (PCD) was used for drainage of the abscess in 43 patients (group 1), while the other 43 patients were managed with open drainage (group 2). Cure was defined as complete obliteration of the abscess cavity. The cure rates, complications, and hospital stay were compared between both groups. Results: The study included 50 males and 36 females with mean age 44.2 ± 17.3. The most common predisposing factors were diabetes mellitus and/or stones. Open drainage of perinephric abscesses resulted in a statistically significant higher cure rate (98% versus 69%, p < 0.001) and shorter hospital stay than PCD (3.6 versus 6 days, p < 0.001). Failure of complete drainage of multilocular abscess was observed in 8 of 13 cases (61.5%) in group 1 and one of 38 cases (2.6%) in group 2 (P < 0.001). Complications were observed in 7% of group 1 and 11.5% in group 2 (P = 0.45). After mean follow-up of 19 months, 9 of 46 patients (19.6%) had recurrence; 7 of them were in group 1. Conclusion: Percutaneous drainage of perinephric abscess is an effective minimally invasive treatment. However, PCD is not the optimal method for drainage of multilocular abscess because open surgical drainage provided higher cure rates and shorter hospitalization than PCD.

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Section: Commentsmentioning

confidence: 99%

“…The general consensus is that large abscesses and patients with predisposing factors require drainage in addition to antibiotics (12,13). Therefore, antibiotics without drainage are suitable for selected cases and the decision to treat with antibiotics alone requires consideration of other associated medical conditions (1).…”

Section: Commentsmentioning

confidence: 99%

What is the best drainage method for a perinephric abscess?

et al. 2010

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“…Salmonella abscesses are rare and reported in only a few case reports [13][14][15][16][17][18][19][20][21][22]. The literature shows that treatment can range from conservative to invasive for renal Salmonella abscesses [23][24][25][26]. Management varied but usual treatment included percutaneous drainage with susceptible antibiotic treatment by IV or PO of antibiotics ceftriaxone, ciprofloxacin and evenofloxacin.…”

Section: Discussionmentioning

confidence: 99%

Salmonella abscess in a Failed Transplanted Kidney

Dejman¹

2017

INID

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An abscess in the kidney is due to salmonellae are rare in the literature and rarer in kidney-transplant patients. The etiology of such abscesses can be difficult to decipher. Salmonella enteric subspecies I serotypes can cause disease in a range of hosts depending on their adaptations. Human host restricted serotypes of typhi, paratyphi A and sendai tend to cause more systemic infections as they are thought to be more adapted to their host. Unrestricted host Salmonella species usually include typhirium and enteritidis and mostly cause self-limited gastroenteritis symptoms but in a range of higher vertebrates [1]. The CDC estimates there are 1.2 million Salmonella infections per year with surveillance data indicating Salmonella serovar enteritidis being the most common serotype followed by Salmonella serovar typhimurium and Salmonella serovar newport. Chicken eggs are known source of these salmonellae outbreaks [2,3]. The patient's history presents a compelling possibility of a previous systemic infection of Salmonella prior to presentation that could have seeded her kidney transplant leading its destruction via abscess. Although full sero typing was not completed, O antigen reactivity did not indicate it was from one of the common subspecies found on surveillance data. Successful treatment included systemic antibiotics with percutaneous drainage. This case report details the rare possibility of a systemic Salmonella infection seeding and destroying a failed kidney graft with subsequent management. Case Presentation53-year-old Jamaican woman with history of hypertension, diabetes mellitus type 2 and end-stage renal disease presented to an outside hospital in December 2013. The patient was admitted with altered mental status, fevers, abdominal pain, fatigue and anorexia ongoing for two months, but without diarrhea. Her graft history dates to 2007 after receiving a deceased donor kidney transplant but failed after graft rejection and resumed hemodialysis in February 2013. Her remaining immunosuppression at time of presentation was prednisone. After resuscitation, she recovered mental status, but abdominal pain persisted which prompted imaging with an MRI showing a fluid collection and air pockets in the right lower quadrant of the abdomen, abutting the right psoas muscle. The patient was started on vancomycin at that time due to concern for Staphylococcus aureus. CT guided abscess drainage on day 5 of hospitalization retrieved 20mL of purulent material that was sent for gram stain and culturing. Gram stain showed 5-10 WBCs (1+) and rare 1-2 gram positive cocci per slide; however, despite no gram negative rods in the smear, few colonies of Salmonella grew from automated aerobic cultures on proprietary media. The patient was changed to ciprofloxacin 200mg BID IV on approximately day 8 th based on Salmonella sensitivities. She was a febrile for the remainder of her hospital course. Final sero typing on day 16 indicated Salmonella enterica subspecies sero type Group O: 47, 48, or 50. Unfortunately due to time and outs...

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“…of RAs and PNAs [3,7,10,11] . Anatomical malformation of the urinary tract, vesicoureteral reflux and obstructive tumors in renal polycystic disease are other previously described risk factors [1,18] .…”

Section: Discussionmentioning

confidence: 99%

Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study

Liu

Cheng-cheng

Liu

et al. 2016

WJN

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AIM:To elucidate the clinical, radiological and laboratory profiles of renal abscess (RA) and perinephric abscess (PNA), along with related treatment and outcome. METHODS:Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identified from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition (ICD-10) codes (RA: N15.101, PNA: N15.102) between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients' characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance profiles, treatment approaches, and clinical outcomes were collected and analyzed. RESULTS:The mean age of the patients was 46.49 years with a male to female ratio of 41:57. Lumbar pain (76.5%) and fever (53.1%) were the most common symptoms. Other symptoms and signs included chills (28.6%), anorexia and vomiting (25.5%), lethargy (10.2%), abdominal pain (11.2%), flank mass (12.2%), flank fistula (2.0%), gross hematuria (7.1%), frequency (14.3%), dysuria (9.2%), pyuria (5.1%) and weight loss (1.0%). Painful percussion of the costovertebral angle (87.8%) was the most common physical finding. The main predisposing factors were lithiasis (48.0%), diabetes mellitus (33.7%) followed by history of urological surgery (16.3%), urinary tract infections (14.3%), renal function impairment (13.3%), liver cirrhosis (2.0%), neurogenic bladder (1.0%), renal cyst (1.0%), hydronephrosis (1.0%), chronic hepatitis B (1.0%), post-discectomy (1.0%) and post-colectomy (1.0%). Ultrasound (US) and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice.Escherichia coli (51.4%), Staphylococcus aureus (10.0%) and Klebsiella pneumoniae (8.6%) were the main causative microorganisms. Intravenous antibiotic Retrospective Study ORIGINAL ARTICLEtherapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and nonresponders. CONCLUSION:Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.

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Renal and Perinephric Abscesses Revisited

Abstract: Renal and perinephric space infection continues to be a serious urological problem with high mortality rate. A high index of suspicion, prompt diagnosis, appropriate antibiotics and surgical intervention may be effective in reducing mortality.

Cited by 20 publications

References 8 publications

What is the best drainage method for a perinephric abscess?

What is the best drainage method for a perinephric abscess?

Salmonella abscess in a Failed Transplanted Kidney

Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study

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