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Perinephric abscess

Last updated: December 13, 2019

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

References:[1][2][3][4][5]

Clinical features

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

References:[1][2]

Diagnostics

Laboratory tests

Imaging

References:[1][2]

Treatment

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!References:[1][2]

Complications

References:[1][2]

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

References

  1. Meyrier A. Renal and Perinephric Abscess. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/renal-and-perinephric-abscess.Last updated: November 3, 2017. Accessed: January 19, 2019.
  2. Kim ED. Perinephric Abscess. In: Fields Schwartz B, Perinephric Abscess. New York, NY: WebMD. https://emedicine.medscape.com/article/439831. Updated: May 2, 2016. Accessed: January 19, 2019.
  3. Lee BE, Seol HY, Kim TK, et al. Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases. Korean J Intern Med. 2008; 23 (3): p.140. doi: 10.3904/kjim.2008.23.3.140 . | Open in Read by QxMD
  4. Balkan II, Savas A, Geduk A, Yemisen M, Mete B, Ozaras R. Candida glabrata perinephric abscess. Eurasian J Med. 2011; 43 (1): p.63-65. doi: 10.5152/eajm.2011.14 . | Open in Read by QxMD
  5. Jacobson D, Gilleland J, Cameron B, Rosenbloom E. Perinephric abscesses in the pediatric population: case presentation and review of the literature. Pediatr Nephrol. 2014; 29 (5): p.919-925. doi: 10.1007/s00467-013-2702-6 . | Open in Read by QxMD