Journal List > Korean J Urol > v.49(10) > 1005207

Sung, Chung, Choi, Rhew, and Lee: Renal and Perinephric Abscesses: Ten Years Experience at a Single Center

Abstract

Materials and Methods

We reviewed the medical records of 33 patients with renal, perinephric, and mixed abscesses treated at our hospital between January 1998 and March 2008. The medical records, including predisposing conditions, clinical manifestations, physical examination, laboratory and radiologic findings, duration of hospitalization, types of uropathogens, time to clinical improvement, time to laboratory improvement, treatment, and clinical outcomes, were retrospectively analyzed.

Results

Renal, perinephric and mixed abscesses occurred in 22 (66.7%), 4 (12.1%), and 7 (21.2%) patients. The most common predisposing conditions were diabetes mellitus (39.4%) and liver disease (27.3%). Flank pain (57.6%) and fever (54.5%) were the most common symptoms. Urine and blood cultures were positive in 23.3 and 19.2% of patients, respectively. The most common isolated uropathogen in the urine, blood, and purulent cultures was E. coli. The time to clinical and laboratory improvement was not significantly different between the patients with renal, perinephric, and mixed abscesses. Patients with renal, perinephric, and mixed abscesses received antibiotic therapy only in 59.1, 50.0, and 42.9% of cases, respectively. Similarly, patients with renal, perinephric, and mixed abscesses underwent percutaneous or surgical drainage in 22.7, 50.0, and 14.3% of cases, respectively. Patients required a nephrectomy in 18.2 and 42.9% of renal and mixed abscess cases, respectively. Most patients were cured (54.5%) or improved (42.4%) at the time of discharge from the hospital.

Purpose

We analyzed the clinical experiences of patients with renal, perinephric, and mixed abscesses during the last 10 years in a single center.

Conclusions

We suggest that renal, perinephric, and mixed abscesses are successfully managed by proper medical or interventional treatment. However, the cases suspicious for renal cancer or with non-functioning kidneys must be evaluated carefully for nephrectomy.

References

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Table 1.
Characteristics of patients with renal, perinephric, and mixed abscesses
  Renal Perirenal Mixed Total
  (%) (%) (%) (%)
n 22 (66.7) 4 (12.1) 7 (21.2) 33 (100)
Mean age (years) 50.3±15.7 49.3±14.7 47.6±17.2 49.6±15.4
Gender        
Male 8 (36.4) 3 (75.0) 2 (28.6) 13 (39.4)
Female 14 (63.6) 1 (25.0) 5 (71.4) 20 (60.6)
Abscess side        
Right 9 (40.9) 1 (25.0) 5 (71.4) 15 (45.4)
Left 10 (45.5) 2 (50.0) 2 (28.6) 14 (42.4)
Both 1 (4.5) 1 (25.0) 0 (0) 2 (6.1)
Graft 2 (9.1) 0 (0) 0 (0) 2 (6.1)
Table 2.
Factors associated with the development of renal, perinephric, and mixed abscesses
  Renal Perirenal Mixed Total
(%) (%) (%) (%)
Associated factors        
Diabetes mellitus 8 (36.4) 2 (50.0) 3 (42.9) 13 (39.4)
Liver disease 6 (27.3) 3 (75.0) 0 (0) 9 (27.3)
Ureteral obstruction 3 (13.6) 0 (0) 0 (0) 3 (9.1)
Nephrolithiasis 0 (0) 0 (0) 2 (28.6) 2 (6.1)
Immunosuppression 2 (9.1) 0 (0) 0 (0) 2 (6.1)
Hypertension 2 (9.1) 0 (0) 0 (0) 2 (6.1)
Chronic renal failure 2 (9.1) 0 (0) 0 (0) 2 (6.1)
Chronic urinary retention 0 (0) 1 (25.0) 0 (0) 1 (3.0)
Ureterosigmoidostomy 1 (4.5) 0 (0) 0 (0) 1 (3.0)
Gout 1 (4.5) 0 (0) 0 (0) 1 (3.0)
None 5 (27.3) 1 (25.0) 3 (42.9) 9 (27.3)
Total 22 4 7 33
Table 3.
Clinical presentations of renal, perinephric, and mixed abscesses
  Renal Perirenal Mixed Total
(%) (%) (%) (%)
Symptoms        
Flank pain 11 (50.0) 2 (50.0) 6 (85.7) 19 (57.6)
Fever 13 (59.1) 2 (50.0) 3 (42.9) 18 (54.5)
Chilling 4 (18.2) 0 (0) 2 (28.6) 6 (18.2)
General weakness 2 (9.1) 1 (25.0) 0 (0) 3 (9.1)
Abdominal pain 1 (4.5) 0 (0) 1 (14.3) 2 (6.1)
Dysuria 1 (4.5) 0 (0) 0 (0) 1 (3.0)
Hypotension 1 (4.5) 0 (0) 0 (0) 1 (3.0)
Mental change 0 (0) 1 (25.0) 0 (0) 1 (3.0)
Myalgia 1 (4.5) 0 (0) 0 (0) 1 (3.0)
Physical examination        
findings        
Costovertebral angle tenderness 19 (86.4) 3 (75.0) 5 (71.4) 27 (81.8)
Costovertebral angle tenderness Palpable mass 1 (4.5) 0 (0) 0 (0) 1 (3.0)
Total 22 4 7 33 (100)
Table 4.
Culture results of renal, perinephric, and mixed abscesses
  Urine (%) Blood (%) ) Pus (%)
Escherichia coli 2 (28.6) 2 (40.0) 2 (28.6)
Escherichia coli, Streptococcus viridans 0 (0) 0 (0) 1 (14.3)
Escherichia coli, Enterococcus species 0 (0) 0 (0) 1 (14.3)
Enterococcus species 2 (28.6) 0 (0) 0 (0)
Staphylococcus aureus 0 (0) 2 (40.0) 0 (0)
Klebsiella pneumoniae 1 (14.3) 0 (0) 2 (28.6)
Proteus mirabilis 0 (0) 1 (20.0) 0 (0)
Non hemolytic streptococcus 0 (0) 0 (0) 1 (14.3)
Yeast 1 (14.3) 0 (0) 0 (0)
Corynebacterium 1 (14.3) 0 (0) 0 (0)
Total 7 5 7
Table 5.
Time to improvement of renal, perinephric, and mixed abscesses
  Renal Perinephric Mixed Total
Mean hospitalized days (days)∗ 18.0±15.5 22.8±16.1 21.7±22.8 19.3±16.8
Mean clinical symptom improvement duration (days) 5.3±6.9 7.5±6.4 6.0±3.6 5.6±6.2
Mean fever improvement duration (days) 2.9±4.1 6.0±8.5 3.2±3.7 3.2±4.2
Mean WBC count improvement duration (days) 9.5±11.6 15.5±14.5 11.8±7.6 10.7±11.2
Mean pyuria improvement duration (days) 19.7±29.5 18.0±21.0 21.3±21.3 19.8±26.2
Mean ESR improvement duration (days)       5.8±9.6

p>0.05, ESR: erythrocyte sedimentation rate, WBC: white blood cell

Table 6.
Treatment outcomes of patients with renal, perinephric, and mixed abscesses
Abscess localization Treatment outcome Ab Tx., n (%) PCD, n (%) OD, n (%) Nx., n (%) Total, n (%)
Renal Cured 7 (53.8) 2 (15.4) 1 (7.7) 3 (23.1) 13 (59.1)
  Improvement 5 (62.5) 2 (25.0) 0 (0) 1 (12.5) 8 (36.4)
  Death 1 (100) 0 (0) 0 (0) 0 (0) 1 (4.5)
  Total 13 (59.1) 4 (18.2) 1 (4.5) 4 (18.2) 22 (100)
Perinephric Cured 1 (50.0) 1 (50.0) 0 (0) 0 (0) 2 (50.0)
  Improvement 1 (50.0) 1 (50.0) 0 (0) 0 (0) 2 (50.0)
  Total 2 (50.0) 2 (50.0) 0 (0) 0 (0) 4 (100)
Mixed Cured 1 (33.3) 0 (0) 0 (0) 2 (66.7) 3 (42.9)
  Improvement 2 (50.0) 0 (0) 1 (25.0) 1 (25.0) 4 (57.1)
  Total 3 (42.9) 0 (0) 1 (14.3) 3 (42.9) 7 (100)

Ab Tx.: antibiotic therapy only, PCD: percutaneous drainage, OD: surgical drainage, Nx.: nephrectomy

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