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Perinephric Abscess
Aka: Perinephric Abscess, Peri-Nephric Abscess, Perirenal Abscess, Peri-Renal Abscess
- See Also
- Pyelonephritis
- Urinary Tract Infection
- Definitions
- Perinephric Abscess (Perirenal Abscess)
- Abscess located outside the renal capsule, but within Gerota's space and fascia
- May extend to involve the psoas muscles, peritoneum and Pelvis
- Renal abscess
- Abscess within the renal parenchyma
- Causes
- Most Common
- Urinary Tract Infection Complication (75%)
- Escherichia coli
- KlebsiellaPneumoniae
- Staphylococcal Aureus Bacteremia
- Hematogenous spread
- In the pre-antibiotic era, was the most common cause of Perinephric Abscess
- Less common source in developed countries
- Renal Trauma
- Regional contiguous infection spread
- Crohn's Disease
- Acute Cholecystitis
- Acute appendicitis with rupture appendix
- Pelvic Inflammatory Disease
- Risk Factors
- Diabetes Mellitus
- Pregnancy
- Urinary Tract Infection
- Nephrolithiasis or Ureterolithiasis (found in 20% of cases)
- Vesicoureteral reflux
- Neurogenic Bladder
- Polycystic Kidney Disease
- Symptoms
- Fever (75%) and chills
- Fever often persists despite UTI infection management >4-5 days
- Flank Pain
- Abdominal Pain
- Pain may be referred to inguinal region
- Frequently absent are Urinary Tract Infection symptoms
- Signs
- Costovertebral Angle Tenderness (CVA Tenderness)
- Present in 75% of patients
- Labs
- Complete Blood Count
- Basic chemistry panel (e.g. chem8)
- Urinalysis
- Normal urine does NOT exclude Perinephric Abscess
- Abscess may not communicate with collecting system
- Urine Culture
- Blood Cultures
- Consider ESR, C-RP
- Imaging
- CT Abdomen and Pelvis with contrast (preferred)
- Identifies abscess and contiguous involvement
- Excludes concurrent Ureterolithiasis
- Management
- Antibiotics for 14-21 days
- Gram Negative Bacteria (most common in developed countries)
- See Acute Pyelonephritis
- Initial antibiotics cover both urinary tract source and Staphylococcus aureus
- Staphylococcal Bacteremia (hematogenous seeding, less common)
- Coverage for MRSA with Vancomycin as indicated
- Standard MSSA coverage otherwise (e.g. Cefazolin, Nafcillin)
- Drainage
- Indicated in Perinephric Abscess >3 cm
- Drainage per local expert opinion for abscesses <3 cm (versus antibiotics alone)
- Technique
- Percutaneous catheter (preferred)
- Surgical drainage (Urology)
- Prognosis
- Worse outcomes with Diabetes Mellitus, large abscess, advanced age, Renal Insufficiency
- Complications
- Septic Shock
- Fistula formation (e.g. Small Bowel)
- Renal Hemorrhage
- Contiguous spread (e.g. Pneumonia, peritoneal spread)
- References
- Lee (2008) Korean J Intern Med 23(3): 140-8
- Okafor (2019) Perinephric Abscess, StatPearls, NLM
- https://www.ncbi.nlm.nih.gov/books/NBK536936/
- (2019) Sanford Guide, accessed on IOS, 10/11/2019