• Clinical science

Perinephric abscess (Perirenal abscess)

Summary

A perinephric abscess is a purulent infection located in the perinephric space between the kidney and the Gerota fascia. While it typically occurs secondary to acute pyelonephritis, it may also be caused by hematogenous spread of bacteria from elsewhere in the body (e.g., in IV drug users). Risk factors include diabetes mellitus, pregnancy, and urinary tract obstruction or abnormalities. Perinephric abscess is insidious in onset, with nonspecific symptoms that include flank or abdominal pain, fever, chills, and dysuria. Costovertebral angle tenderness is often present on examination. Abdominal CT is the preferred method to confirm the diagnosis. Abscess drainage and antibiotic therapy are the cornerstones of treatment. Complications include extension of the abscess beyond the Gerota fascia, into the retroperitoneum (paranephric abscess), and sepsis.

Etiology

Clinical features

Onset is often insidious and symptoms are nonspecific, but they may include:

  • Constitutional symptoms (e.g., fever, chills, fatigue)
  • Flank pain, abdominal pain, and/or back pain, with costovertebral angle tenderness on examination (usually unilateral)
  • Dysuria as well as other symptoms of cystitis (e.g., increased urinary frequency, urgency)
  • Palpable unilateral flank mass

Diagnostics

Treatment

  • Abscess drainage
    • Percutaneous, retroperitoneal drainage: preferred method (less likely to lead to complications)
    • Surgical drainage (especially in cases of a large abscess and/or an anatomical abnormality, such as vesicoureteral reflux or a large kidney stone)
  • Antibiotic treatment: may be sufficient in smaller abscesses (< 3 cm) but is usually paired with abscess drainage to avoid complications

If possible, the abscess should be drained before empiric antibiotic therapy is initiated! However, if drainage is not immediately feasible, empiric antibiotics should be started.

“Ubi pus, ibi evacua” (Latin aphorism) – Where there is pus, evacuate it!

Complications

We list the most important complications. The selection is not exhaustive.

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last updated 01/19/2019
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