Renal artery pseudoaneurysm formation and rupture induced by renal abscess: A case report

Severe consequences can ensue from the rupture and hemorrhage of a renal artery pseudoaneurysm, necessitating immediate intervention upon detection. To date, no reports exist on the development of renal artery pseudoaneurysms as a result of renal abscesses. This document introduces the first reported case of this occurrence.

Association between the imaging characteristics of renal abscess and vesicoureteral reflux

INTRODUCTION

Renal abscesses are rare in pediatric populations. We aimed to highlight the differences in the computed tomography (CT) imaging characteristics of renal abscesses in patients with and without vesicoureteral reflux (VUR).

MATERIALS AND METHODS

Thirteen children with renal abscesses were included and categorized into those with and without VUR. Blood and urine culture results were recorded as positive or negative. Imaging characteristics were recorded: with/without subcapsular fluid collection, with/without upper/lower pole involvement, and with single/multiple lesions in kidneys. Fisher's exact test was used for intergroup comparisons of the rate of positive pathogens and imaging characteristics.

RESULTS

Nine patients had VUR (45.9%). Blood and urine culture were positive in two (15.4%) and seven cases (53.8%), respectively. There was no significant difference in the rate of pathogen-positive blood and urine cultures (blood culture positive/negative status with VUR vs. that without VUR = 2/7 vs. 0/4, p > 0.999, urine culture positive/negative status with VUR vs. that without VUR = 4/5 vs. 3/1, p = 0.559). The two groups differed significantly regarding subcapsular fluid collection presence (with/without subcapsular fluid collection with VUR vs. that without VUR = 9/0 vs 1/3, p = 0.014). There was no significant difference in upper/lower pole involvement (with/without involving upper/lower pole with VUR vs. that without VUR = 8/1 vs 2/2, p = 0.203). Patients with VUR were non-significantly more likely to have multiple lesions compared to those without VUR.

CONCLUSIONS

VUR was associated with subcapsular fluid collection and possibly with multiple lesions, indicating the need for prompt detection of and specific treatment for VUR in cases with these findings.

Segmental renal vein thrombosis: An unusual complication of acute pyelonephritis

Renal vein thrombosis is not a common manifestation in the context of acute pyelonephritis. We report the case of a 29-year-old female diabetic patient that was admitted to our department for an episode of complicated acute pyelonephritis. Initial imaging showed a left lower polar abscess of 27 mm and urine cultures grew community acquired K. Pneumoniae. Two days after the patient was discharged, she was readmitted with worsening symptoms. Repeat imaging showed stability in the size of the abscess and revealed a left lower segmental vein thrombosis. The patient responded favorably to antibiotics and heparin-warfarin therapy.

An update on pyelonephritis: role of contrast enhancement ultrasound (CEUS)

Acute pyelonephritis (APN) is a bacterial infection causing inflammation of the kidneys. Diagnosis is usually based on clinical and laboratory findings. Imaging is required if a complication is suspected in acute pyelonephritis to assess the nature and extent of the lesions and to detect underlying causes. CT represents the current imaging modality of choice in clinical practice. CEUS is an alternative that has been proven to be equally accurate in the detection of acute pyelonephritis renal lesions. CEUS allows us to distinguish small simple nephritic involvement from abscess complications and to follow their evolution over time during antibiotic therapy. The absence of ionizing radiation and the lack of nephrotoxicity make CEUS an ideal tool in the study of pyelonephritis.

Role of MRI in the evaluation of acute pyelonephritis in a high-risk population with renal dysfunction: a prospective study

AIMS

This study aims to evaluate the (a) accuracy of conventional and diffusion-weighted-imaging (DWI) sequences in the diagnosis of acute pyelonephritis and (b) minimum apparent diffusion coefficient (ADC) values for the diagnosis of acute pyelonephritis and the differentiation of renal abscesses from acute pyelonephritis.

MATERIALS AND METHODS

Ultrasound, conventional MRI sequences, and DWI were used to evaluate the kidneys in 68 patients suspected to have acute pyelonephritis. Multiple similar regions of interest (ROIs) were placed over the renal parenchyma with visually identifiable diffusion restriction, over the non-diffusion-restricted renal parenchyma of affected kidneys and over the normal kidneys. Corresponding minimum ADCs were noted for analysis. Pyelonephritis was confirmed based on clinical criteria, laboratory findings, and by resolution/development of known complications of pyelonephritis.

RESULT

DWI showed the highest sensitivity(100%), while DWI read with T2-weighted imaging (both being positive) showed the highest specificity(100%) for the diagnosis of acute pyelonephritis in our population with a high baseline creatinine. The minimum-ADC of the nephritic diffusion-restricted area in patients with confirmed pyelonephritis was significantly lower than the minimum-ADC in patients without pyelonephritis [(0.934 ± 0.220, mean ± SD) vs (1.804 ± 0.404) × 10^-3 s/mm²] (p < 0.001). ROC cut-off of minimum-ADC for the diagnosis of acute pyelonephritis was 1.202 × 10^-3 s/mm² (area under curve 0.978). The minimum-ADC of the abscesses were significantly lower when compared to the minimum-ADC of the nephritic diffusion-restricted portion of the same kidney [(0.633 ± 0.248) vs (0.850 ± 0.191) × 10^-3 s/mm²] (p < 0.001).

CONCLUSION

DWI is an excellent stand-alone imaging tool that can be combined with conventional sequences for the diagnosis of APN even in patients with high serum-creatinine or other contraindications to intravenous contrast. Further, ADC values can be used to differentiate between renal abscesses and uncomplicated pyelonephritis.

Incidence of renal scarring on technetium-99 m dimercaptosuccinic acid renal scintigraphy after acute pyelonephritis, acute focal bacterial nephritis, and renal abscess

OBJECTIVE

To evaluate the association between the incidence of renal scarring on technetium-99 m dimercaptosuccinic acid (DMSA) renal scintigraphy and the severity of renal parenchymal infections, such as acute pyelonephritis (APN), acute focal bacterial nephritis (AFBN), and renal abscess, based on computed tomography (CT) diagnosis.

METHODS

Sixty-one children with renal parenchymal infections were included and classified into two groups: those with (renal scarring group) and without renal scarring (non-renal scarring group) on chronic-phase DMSA renal scintigraphy. The severity of renal parenchymal infection was classified into three grades using CT: APN, AFBN, and renal abscess as grades 1, 2, and 3, respectively. The severity of renal parenchymal infection, vesicoureteral reflux (VUR) grade, and intrarenal reflux occurrence during voiding cystourethrography (VCUG) were evaluated between the renal and non-renal scarring groups. Fisher's exact test and Mann-Whitney U test were used for statistical analysis.

RESULTS

Renal scars were detected in 28 (45.9%) of the 61 patients. We found that 2/9 (22.2%), 18/41 (43.9%), and 8/11 (72.7%) patients with APN (grade 1), AFBN (grade 2), and renal abscess (grade 3) had renal scarring, respectively. There was a significant difference in the grade of severity of renal parenchymal infection between the renal (median = 2 [interquartile range, 2-3]) and non-renal (median = 2 [interquartile range, 2-2]) scarring groups (p = 0.023). There was a significant difference in the grade of VUR between the renal (median = 3 [interquartile range, 0-4]) and non-renal (median = 0 [interquartile range, 0-2]) scarring groups (p = 0.004). No significant difference in intrarenal reflux occurrence was observed between the renal (present/absent: 3/25) and non-renal (present/absent: 0/29) scarring groups (p = 0.112).

CONCLUSION

Our results showed that pediatric patients with renal scarring on chronic-phase DMSA renal scintigraphy tended to have a more severe renal infection.

A case of a renal abscess caused by Salmonella bareilly in a previously healthy boy

Background

Renal abscesses are relatively uncommon in children, and usually due to Gram-negative rods or Staphylococcus aureus, whereas abscesses caused by Salmonella are very rare.

Case presentation

We present the case of a previously healthy 10-year-old boy who had a renal abscess due to Salmonella bareilly. He responded well to treatment with antibiotics, and computed tomography (CT)-guided drainage of the abscess. His blood, urine and abscess aspirate cultures were sterile, but a broad-range 16S rDNA polymerase chain reaction (PCR) assay of the aspirate followed by analysis of four Salmonella genes (fliC, fliD, sopE2, and spaO) identified S. bareilly as the causative agent.

Conclusion

To the best of our knowledge, this is the first report of renal abscess caused by S. bareilly.

A case of acute focal bacterial nephritis with acute kidney injury presenting as acute abdomen

Acute focal bacterial nephritis (AFBN) refers to the bacterial infection of the renal parenchyma without abscess formation. Although AFBN has mainly been reported in pediatric patients, it may be underdiagnosed in adults as it resembles acute pyelonephritis in its clinical presentation. However, the symptoms suggesting acute abdomen is an important clue to diagnose AFBN, which requires additional imaging studies such as contrast-enhanced computed tomography (CECT). Here, we present the case of a 49-year-old female presenting to our emergency room with acute abdomen as well as acute kidney injury (AKI). CECT was performed to rule out critical etiologies of severe abdominal pain and the results revealed multifocal wedge-shaped shadows in the right kidney and diffuse enlargement of bilateral kidneys. We diagnosed the patient with AFBN and treated her through temporal hemodialysis (two sessions) and antibiotics for 23 days. Although AKI associated with AFBN has rarely been reported, her renal dysfunction and other symptoms were completely improved. In conclusion, clinicians should be aware of AFBN and be cautious to avoid the unnecessary invasive interventions.

A case of renal abscess and bacteremia caused by Burkholderia pseudomallei that was first unidentifiable by matrix-assisted laser desorption ionization-time of flight mass spectrometry in a Japanese-man

Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in specific regions, including Southeast Asia and Northern Australia. In Japan, where no autochthonous has been reported to date, melioidosis is a rare infectious disease. Herein, we report a case of melioidosis in a 68-year-old Japanese man with renal abscess and bacteremia, but without pneumonia. The patient presented to our hospital and was admitted for fever and chills that have persisted for two months. It was speculated that he was infected in Thailand, where his family lives because he shuttled between Thailand and Japan. Blood cultures on admission identified Burkholderia species; however, the species was unidentifiable by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Further re-examination, including culture, loop-mediated isothermal amplification, and multiplex polymerase chain reaction methods, finally identified Burkholderia pseudomallei. We treated the patient with intravenous ceftazidime for four weeks. In addition to the antibiotics administration, puncture drainage of the renal abscess was performed, and he gradually became afebrile. Intravenous ceftazidime was switched to oral sulfamethoxazole/trimethoprim on post-admission day 32, and he was discharged. After five months of oral sulfamethoxazole/trimethoprim, no recurrence was observed one year after discharge. To diagnose melioidosis, especially in non-endemic areas, a precise and thorough understanding of its epidemiology, presentation, and identification methods is necessary.

[Renal abscess in children]

INTRODUCTION

Renal abscesses are relatively rare in children, but they can lead to prolonged hospital stay and life-threatening complications. Scrutiny of the literature over the past two decades indicates the absence of a unified tactic for the treatment of purulent-destructive forms of pyelonephritis in children, while more and more articles are appearing in terms of a low -key approach to the treatment of renal abscess in children.

MATERIALS AND METHODS

From 2005 to 2019, we treated 59 children with the renal abscess. Among the patients were 22 (37.3%) boys and 37 (62.3%) girls. The location of the abscess on the right was determined in 30 (50.8%) children, on the left, in 29 (49.2%). The average age of the patients was 109 months. The median size of kidney abscess among all patients was 29 [21; 42] mm (range from 12 to 69 mm).

RESULTS

The results of treatment were evaluated in the period from 3 months to 5 years. In 27 (45.8%) patients, conservative treatment gave a positive effect, while in 32 (54.2%) abscess puncture was performed under ultrasound guidance. The median hospitalization in patients after an abscess puncture was 15 [14; 18] days, against 13 [9; 17] days for children receiving only antibiotic therapy. The duration of hospital stay was significantly longer in the group of patients who underwent puncture (p=0.019). The effectiveness of conservative therapy was a lot lower in patients with a kidney abscess of more than 3 cm, 60% versus 31% (p=0.026). All 59 patients recovered completely, and none of them required an open surgery to drain a suppurative focus of a kidney or nephrectomy.

CONCLUSION

Conclusion. Our experience confirms the literature data, indicating the need to use a conservative approach to the treatment of patients with the renal abscess as a first-line therapy. Identification of an abscess with a diameter of more than 3 cm in patients considerably increases the likelihood of using an abscess puncture with the absence of the efficacy of a conservative approach.

Retroperitoneal emphysema caused by a renal abscess: a case report

We report a case of retroperitoneal emphysema caused by a renal abscess. A 45-year-old man with underlying type 2 diabetes mellitus visited the emergency department with right flank pain and a fever. On physical examination, right costovertebral tenderness in the ipsilateral flank was noted. Leukocytosis and high inflammatory marker levels were observed. Urinalysis showed pyuria and glucosuria. Urine culture was positive for Streptococcus agalactiae. A computed tomography scan of the abdomen showed a focal, lowattenuation lesion in the right kidney with a 3 cm, exophytic, high-attenuation lesion in the right kidney upper pole and gas-containing fluid collection within the retroperitoneal space. The diagnosis was retroperitoneal emphysema caused by a renal abscess. As the vital signs were stable and the patient refused puncture, we decided on a course of antibiotics alone with follow-up without percutaneous drainage or surgery. The patient improved without any complications. This is a rare case of a renal abscess penetrating the renal fascia and progressing to a posterior paranephric emphysema. The patient was treated with antibiotics alone and cured successfully. Early diagnosis and proper treatment are needed, and percutaneous drainage or urgent surgery would be beneficial for such cases depending on the patient's condition.

A rare case of emphysematous pyelonephritis associated with pneumatosis intestinalis and bowel ischemia

Emphysematous pyelonephritis (EPN) is a rare life-threatening gas producing kidney infection, commonly affects uncontrolled diabetic patients with underlying urinary tract obstruction. Presence of pneumoperitoneum and involvement of the bowels are uncommon presentation of EPN. In the present report, we present a 59-year-old African male who had extensive EPN with pneumoperitoneum, pneumatosis intestinalis and extension to the bowel causing ischemia. Successful surgical exploration was done, with resection anastomosis of the ischemic bowel segment and drainage of the kidney.

Red blood cell distribution width may be a new factor that influence the selection of invasive treatment in patients with renal abscess

BACKGROUND

Red blood cell distribution width (RDW) is associated with the severe morbidity and mortality of some Gram-negative associated chronic diseases. We designed this retrospective study to identify whether RDW can be used as a factor to provide reference for the treatment of renal abscess.

METHODS

All patients with renal abscess in our institution between April 2016 and November 2019 were collected, and 38 cases with the characteristic of initially diagnosis and no prior treatment were enrolled. Conservative treatment group and surgical intervention group were set based on the treatment of patients. Univariate analysis and the regression analysis were adopted to identify the difference between these two groups.

RESULTS

Significant differences were found in Diabetes mellitus, RDW and size of renal abscess in both univariate and multifactor analysis. The median value of RDW in all patients was 13.62%, with 13.15% in conservative treatment group and 14.20% receiving surgical intervention (OR: 9.48, 95% CI: 1.15-78.02). Diabetes was present in 42.11% of patients, with the ratio of 20.0% in conservative treatment group and 66.67% in surgical intervention group (OR: 35.22, 95% CI: 1.55-799.05). The cut-off of RDW and size of renal abscess were 14.07% and 3.9 cm respectively.

CONCLUSIONS

RDW as an independent predictor of mortality in patients with Gram-negative bacteremia showed differences among patients with renal abscess who received different treatments. Since the relationship between RDW and Gram-negative bacteremia related to mortality, higher initial RDW value may represent a higher severity of renal abscess and a greater likelihood of the need of surgical intervention.

Renal abscess caused by Panton-Valentine leukocidin-producing Staphylococcus aureus: report of an unusual case and review of the literature

BACKGROUND

Renal abscesses are rare and mainly caused by an ascending infection due to Gram-negative microorganisms. We report the first case of a renal abscess caused by Panton-Valentine leukocidin-producing Staphylococcus aureus in an immunocompetent patient, and we present a comprehensive review of the literature.

CASE PRESENTATION

A 20-year-old immunocompetent woman had a 2-month history of left-sided back pain, fever and urinary symptoms. Urinalysis showed leukocyturia (19,000/mm³) without bacteriuria. Intravenous cefotaxime treatment was initiated. A computed tomographic scan showed a large abscess in the left kidney. Computed tomographic percutaneous drainage was done and cultures of abscess and blood grew methicillin-susceptible Panton-Valentine leukocidin-producing Staphylococcus aureus. Treatment was switched to cefazoline and then to clindamycin for 21 days. The patient quickly improved and the abscess was completely resolved 6 months after end of antibiotic treatment.

CONCLUSION

To our knowledge, this is the first report of a renal abscess caused by Panton-Valentine leukocidin-producing Staphylococcus aureus. Treatment with percutaneous drainage and an antibiotic with toxin inhibiting effect was successful.

A case of HDR syndrome coexisting with tetralogy of Fallot, with a novel GATA3 mutation, which manifested as a renal abscess

HDR syndrome is characterized by the triad of primary hypoparathyroidism, sensorineural hearing loss and renal malformation with widely variable manifestations. It is an autosomal dominant inherited disease caused by a mutation of the GATA3 (NM_001002295.2), which is located on chromosome 10p14. Congenital heart disease, such as tetralogy of Fallot, a typical complication of DiGeorge syndrome, is a rare complication of HDR syndrome. We herein report a case of HDR syndrome coexisting tetralogy of Fallot with a novel mutation, c.964C > T (p.Gln322*). This case suggested that the screening of renal involvement should be carefully performed in patients with a phenotypic combination of hypoparathyroidism and sensorineural hearing loss, to facilitate the early diagnosis of HDR syndrome. In addition, when the deletion of chromosome 22q11.2 is not detected by a fluorescence in situ hybridization analysis in patients exhibiting the partial phenotype of DiGeorge syndrome, the possibility of HDR syndrome should be considered and the renal function should be repeatedly evaluated.

Renal abscess with bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli: a case report

Background

Renal abscess in children is a rare and severe form of infectious kidney disease that is responsible for several serious complications. In this report, we describe a previously healthy 5-year-old girl with a renal abscess caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli), which led to bacteremia and renal scarring.

Case presentation

The patient presented to our department with high fever, headache, vomiting for 2 days and high inflammatory response. We diagnosed her with a urinary tract infection and initiated treatment with ampicillin and cefotaxime. Gram-negative bacilli bacteremia was noted on day 3. On day 4, her fever persisted, and a computed tomography (CT) scan revealed a renal abscess in the left kidney. After identifying the bacteria as ESBL-producing E. coli from the blood culture, we switched to the antibiotic meropenem and continued treatment for 3 weeks. The renal abscess was not drained. Although the renal abscess was successfully treated and it disappeared, a low-density area remained in same lesion on subsequent CT scans and a dimercaptosuccinic acid renal scan performed 4 months after onset revealed renal scarring.

Conclusion

Given the increasing prevalence of ESBL-producing microorganisms, clinicians should be aware of the possibility of renal abscesses caused by community-acquired ESBL-producing organisms even in previously healthy children. Once a renal abscess is suspected, early diagnosis and management are important for reducing the risk of life-threating complications and renal scarring.

Analysis of 17 children with renal abscess

PURPOSE

This study's aims to analyze the clinical characteristics of children with renal abscess and improve its diagnosis and treatment.

METHODS

The clinical data of children diagnosed with renal abscess in our hospital from 2007 to 2016 were retrospectively analyzed, including clinical manifestations, laboratory tests, imaging examinations, and treatment measures.

RESULTS

17 children with renal abscess were enrolled with median age was 15 (1.5-163) months old. There were 7 girls and 10 boys. Fever was the most common symptom (82.4%). 58.9% of children suffered from abnormal urogenital function before onset, mainly manifested as ureteral abnormalities (41.2%), renal dysplasia, or non-functioning kidneys (17.6%). Acute C-reactive protein and erythrocyte sedimentation rate (ESR) were increased in more than 85% patients, but the elevation of procalcitonin was not significant (10%). 41.2% of the children had anemia, and 64.7% exhibited markedly elevated leukocytosis. All cases were negative by blood culture. The pathogen was mainly Gram-negative bacteria (47.1%), including Escherichia coli. The detection rate of Enterococcus and Candida albicans was 23.5%. Mycobacterium tuberculosis was found in 1 case. B-ultrasound and magnetic resonance imaging were most commonly used. All cases received anti-infective treatment. 10 cases were ineffective and underwent surgical treatment. There was a significant difference in the treatment outcome between abscesses larger and smaller than 4 cm (P < 0.05).

CONCLUSION

For children with fever, abdominal pain, or flank pain, together with elevated white blood cell count, CRP, ESR, and IL-6, especially when anti-infective effect is poor, renal abscess should be considered. The initial anti-infective treatment of renal abscess can use a step-down scheme. The regimen needs to strengthen the anti-Gram positive bacteria and fungal treatment, and consider the possibility of renal tuberculosis infection. Conservative anti-infective treatment can be used in children with abscess size smaller than 4 cm, while surgery is recommended in abscesses larger than 4 cm not responsive to drug therapy.

Evaluation and Management of Urinary Tract Infection in the Emergency Department

Urinary tract infection (UTI) affects patients of all ages and is a diagnosis that emergency physicians might make multiple times per shift. This article reviews the evaluation and management of patients with infections of the urinary tract. Definitions of asymptomatic bacteriuria, uncomplicated UTI, and complicated UTI are presented, as well as techniques for distinguishing them. The pathophysiology and clinical and laboratory diagnoses of UTI are described. Treatment of UTI is reviewed, with attention to bacteriuria and special populations, including pregnant, elderly/geriatric, and spinal cord injury patients.

Candida Tropicalis renal microabscesses in a child with leukemia confirmed using nucleic acid amplification and recovery after prolonged antifungal and corticosteroid treatment

We report the first case of microabscesses detected by polymerase chain reaction (PCR) amplification of nucleic acid from ultrasound-guided aspirated fluid in a three-year old boy with acute lymphoblastic leukemia and febrile neutropenia during induction chemotherapy. Fever persisted despite effective antifungal treatment. The addition of corticosteroid therapy successfully controlled the suspected immune reconstitution inflammatory syndrome (IRIS). This case highlights the utility of PCR and adjunctive corticosteroid in the approach of Candida tropicalis renal microabscesses in leukemic patients undergoing chemotherapy.

Simultaneous occurrence of hypermucoviscous Klebsiella pneumoniae emphysematous prostatic abscess, emphysematous cystitis, and renal abscess

Emphysematous prostatic abscess is a rare clinical entity of uncomplicated urinary tract infections with high mortality rate. Here we report a case of hypermucoviscous Klebsiella pneumoniae causing emphysematous prostatic abscess, emphysematous cystitis, and renal abscess simultaneously in a 75-year-old Japanese male with diabetes mellitus and advanced gastric cancer. The patient was successfully treated with prolonged intravenous antimicrobial agents.

Renal vein thrombosis complicating severe acute pyelonephritis with renal abscesses and associated bacteraemia caused by extended-spectrum beta-lactamase producing Escherichia coli

Acute pyelonephritis might be complicated by the formation of renal and perirenal abscesses and very rarely by renal vein thrombosis, which is a life-threatening condition. The main causative agents of acute pyelonephritis are enterobacteriaceae with the incidence of extended-spectrum beta-lactamase (ESBL)-producing strains increasing worldwide. We present the case of a 71-year-old Greek man with history of diabetes mellitus and recent hospitalization, who suffered from severe pyelonephritis with renal abscesses formation and associated bacteraemia caused by ESBL-producing Escherichia coli, complicated by extensive thrombosis of the ipsilateral renal vein and its branches, protruding also in the inferior venal cava. Our patient was effectively treated with anticoagulants and targeted antibiotic therapy, respectively, consisted of low molecular weight heparin transitioned to oral acenocoumarol for 3 months and 2-week course of intravenous meropenem followed by oral fosfomycin for additional 3 weeks as quidded by clinical and computed tomographic follow-up. In conclusion, in complicated urinary infections, caused by ESBL-producing enterobacteriaceae, oral fosfomycin might represent an effective option for step-down therapy of carbapenems, allowing the shortness of the duration of patient's hospitalization and carbapenem use.

Acute Pyelonephritis - Correlation of Clinical Parameter with Radiological Imaging Abnormalities

INTRODUCTION

Pyelonephritis (PN) is a suppurative infection of the kidney, most commonly due to bacterial infection and may be either acute or chronic. Acute PN (APN) subdivided into uncomplicated and complicated. Severity of PN cannot be assessed by clinical or laboratorial parameters alone, radiological imaging such as Ultrasound (USG) abdomen, Computed Tomography (CT) is required to know the nature, extent and severity of disease and for planning interventions.

AIM

The aim of this study was to compare clinical and biochemical parameters with radiological findings (USG/CT) among patients diagnosed to have PN.

MATERIALS AND METHODS

The medical records of all patients admitted with PN at the Institute of Nephrourology, Bangalore from January 2016 to December 2016 were reviewed. Their clinical and biochemical parameter were compared with radiological findings. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) Version 15.0.

RESULTS

There were 100 patients diagnosed with PN in the study period. Mean age of patient was 48.7 years and PN was common among females (62%). Classical triad of PN was present in 87% of patients. Acute kidney injury was present in 47% of patients. Diabetes (69%) was the most common comorbid condition. Positive urine culture was found in 24% of patients. USG abdomen was performed in all patients and it was suggestive of APN in 66% cases. CT abdomen was available for 74% and it revealed PN in 70%, of patients. Among these Emphysematous PN (EPN) was found in 4% and renal abscess in 3% of patients. In this study, USG findings of PN were correlated with triad of PN symptoms and those who had PN for the first time.

CONCLUSION

In this study, majority of the patients presented with clinical triad of PN-fever, flank pain and dysuria. Urine culture was positive only in few cases. USG was able to diagnose large number of PN cases except emphysematous change and renal abscess which was detected by CT. The detection of PN was better with CT when compared to USG.

Serial sonographic findings during progression from acute pyelonephritis to renal abscess: a rare case report

Renal abscess, accumulation of infective fluid in the kidney, is a rare pathology. Currently, no reports of the serial imaging changes of acute pyelonephritis (APN) progressing to renal abscess exist. We report clinical and serial sonographic findings of a patient with hyper-immunoglobulin E syndrome, a primary immunodeficiency, who developed APN that progressed to renal abscess. Renal ultrasonography revealed that echogenicity of infectious lesions dramatically changed from isoechoic to hyperechoic and to hypoechoic during progression. These findings are useful for differential diagnosis of APN, acute focal bacterial nephritis, and renal abscess.

Pediatric renal abscesses: A contemporary series

INTRODUCTION

Pediatric renal abscesses are an uncommon diagnosis, with a paucity of data comparing treatment modalities. Patient presentation ranges from persistent dull flank/abdominal pain with or without fevers, to those who are overtly ill, presenting with hemodynamic instability and bacteremia. Management for pediatric renal abscesses is typically based on results extrapolated from small series in adult cohorts, with conservative measures recommended when the lesion is <3 cm.

OBJECTIVE

This study evaluated the presentation, management and outcomes of a contemporary cohort of pediatric patients with renal abscesses.

STUDY DESIGN

A total of 16 consecutive pediatric patients with radiologically diagnosed intra-renal or peri-nephric abscesses from 1990 to 2012 were identified. Patients were identified by querying institutional records via ICD-9 and CPT codes referencing renal abscess. Charts were retrospectively reviewed to evaluate multiple clinical variables, including: presenting symptoms, size of abscess, management strategy and clinical outcomes. Clinical resolution was confirmed via repeat ultrasound or computed tomography.

RESULTS

The median age at presentation was 13 years (range 1 month-18 years) and 13/16 patients (81%) were female. Abscess formation was secondary to: urinary tract infection in 13 (81%); hematogenous seeding from a skin infection in one (6%); and an unknown etiology in two (12%) patients. The most common organism identified on urine culture was Escherichia coli (10, 77%). Hematogenous seeding was confirmed in only one case, with Staphylococcus aureus growing on culture from both a cutaneous lesion and percutaneous drainage of the renal lesion. Overall, abscesses were a median of 2.2 cm (IQR 2, 3.7), with 13 (81%) successfully managed with conservative therapy, including intravenous antibiotics, with resolution on repeat imaging at a median of 21 days (range 6-55). For patients presenting with abscesses ≤3 cm, conservative measures were employed in 10/11 cases, with 100% success rate. Three patients had larger abscesses (3.8, 4, and 10 cm), which resolved after treatment with percutaneous drainage. A voiding cystourethrogram was performed in 10 patients, with two (20%) detecting an abnormality (low-grade vesicoureteral reflux, which required no further intervention).

CONCLUSIONS

Pediatric renal abscesses were most commonly small and secondary to an E. coli UTI. Most small (≤3 cm) renal abscesses resolved with conservative management. Percutaneous drainage should be considered for lesions >3 cm and in patients who remain persistently febrile, despite culture-specific antibiotics, are immunocompromised or critically ill.

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

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 therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders.

CONCLUSION: Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.

Acute focal bacterial nephritis, pyonephrosis and renal abscess in children

BACKGROUND-AIM

Acute focal bacterial nephritis (AFBN), renal abscess and pyonephrosis are uncommon and not fully addressed forms of urinary tract infection (UTI) which may be underdiagnosed without the appropriate imaging studies. Here, we review the characteristics and outcome of these renal entities in children managed at a single medial centre.

PATIENTS AND METHODS

The medical files of all children hospitalized for episodes of AFBN, renal abscess and pyonephrosis during a 10-year period (2003-2012) were reviewed.

RESULTS

Among the 602 children hospitalized for UTI, 21 presented with AFBN, one with abscess and three with pyonephrosis. All 25 children (13 girls), ranging in age from 0.06 to 13.4 years, were admitted with fever and an impaired clinical condition, and 18 had urological abnormalities. More than one lesion, often of different types, were identified in 11 episodes. Urine cultures from 13 episodes grew non-Escherichia coli pathogens and those from two episodes were negative. Antibiotics were administered for 14-60 days, and emergency surgery was required in three cases. During follow-up, 13 patients underwent corrective surgery. Permanent renal lesions were identified in 16 patients.

CONCLUSIONS

AFBN, renal abscess and pyonephrosis should be suspected in children with severe presentation and urological history. Appropriate imaging is crucial for management planning. Prognosis is often guarded despite appropriate treatment. Based on the results of this study we propose a management algorithm.

Management of renal cell carcinoma presenting as inflammatory renal mass

Introduction:

Renal cell carcinoma (RCC) can have a wide spectrum of clinical presentations. In the immunocompromised patient fever and an inflammatory renal mass can harbor RCC.

Materials and Methods:

We reviewed the charts of patients who were managed at our department during 1998-2008 as renal abscess or perinephric collection. Renal ultrasound and subsequently abdominal CT was done. Medical treatment in the form of antibiotics, control of diabetes and drainage was done. Percutaneous or open biopsy, pus cultures, and histopathology were used to guide therapy. With a positive biopsy radical surgery was considered, while with a negative result a follow up CT was planned.

Results:

We identified 11 patients who had high fever, a renal abscess (in 4), or a suspicious mass with perinephric collection (in 7), and were eventually diagnosed to have RCC. Mean patient age was 66 years (53-82). 8 patients had uncontrolled diabetes. Five patients had a percutaneous drainage biopsy; of those two had a positive histopathology, the other three patients had a persistent enhancing mass on follow-up CT scan. Of this group three patients underwent radical nephrectomy. Another five patients had open drainage and biopsy, four patients had very poor performance status. One patient had radical surgery without the need for biopsy.

Conclusion:

In the elderly and immunocompromised patient renal cancer may present as renal abscess or perinephric collection. Histopathology and bacteriology are the mainstay of diagnosis. If biopsy was negative, follow up should include a CT scan to exclude any residual enhancing masses.

Management of non-catheter-associated complicated urinary tract infection

This article presents an overview of non-catheter-associated complicated urinary tract infection (UTI) from a urologic point of view. Discussion includes the evaluation and workup a complicated UTI through history, physical examination, laboratory analysis, and radiographic studies. Specific types of complicated UTI, such as urinary obstruction and renal abscess, are reviewed.

Pneumorachis associated with multiorgan infection due to Citrobacter koseri

Pneumorachis rarely occurs after spreading from a contiguous site of infection or after a traumatic event. We describe an adult patient who developed sepsis and a renal abscess due to Citrobacter koseri, and computed tomographic imaging identified gas within the entire spinal canal as well as an iliopsoas abscess. This patient recovered from pneumorachis caused by disseminated infection.

Renal and Perinephric Abscesses Revisited

BACKGROUND

This study was carried out to assess the spectrum of renal and perinephric space infection among urology patients admitted in the last three years.

METHODS

Medical records of patients with renal and perinephric abscess and emphysematous pyelonephritis were reviewed.

RESULTS

Out of 2278 patients admitted in last three years, 29 (1.2%) patients suffered from renal and perinephric space infection, 13 (45%) patients had renal abscess, 11 (38%) perinephric abscess and five (17%) emphysematous pyelonephritis. Sixteen (55%) patients recovered conservatively, nine (31%) patients required percutaneous drainage of the abscesses and remaining four (14%) underwent surgical exploration. The overall mortality was 14% in this study.

CONCLUSION

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.