Renal abscess: Difference between revisions
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==Background== | |||
*Rare clinical entity which can lead to delayed diagnosis | *Rare clinical entity which can lead to delayed diagnosis | ||
*Usually a complication of a UTI or pyelonephritis | *Usually a complication of a [[UTI]] or [[pyelonephritis]] | ||
**Most commonly due to E. Coli, Klebsiella, Proteus | **Most commonly due to [[E. Coli]], [[Klebsiella]], [[Proteus]] | ||
*Less often can be due to hematogenous spread from other sources of infection | *Less often can be due to hematogenous spread from other sources of infection | ||
**Most commonly due to Staph aureus | **Most commonly due to Staph aureus | ||
==Risk Factors== | ===Risk Factors=== | ||
*Inadequately treated or delayed treatment of UTI or pyelonephritis | *Inadequately treated or delayed treatment of [[UTI]] or [[pyelonephritis ]] | ||
*Diabetes | *[[Diabetes]] | ||
*Renal calculi | *[[Renal calculi]] | ||
*Ureteral obstruction | *Ureteral obstruction | ||
*Any underlying urinary tract abnormality | *Any underlying urinary tract abnormality | ||
*Immunosuppression | *Immunosuppression | ||
==Clinical Features== | ==Clinical Features== | ||
*Costovertebral, flank, lumbar, lower chest, or back pain | *Costovertebral, flank, lumbar, lower chest, or back pain | ||
**Usually unilateral | **Usually unilateral | ||
*Fever, especially if prolonged or after antibiotic initiation | *[[Fever]], especially if prolonged or after antibiotic initiation | ||
*Nausea, vomiting | *[[Nausea]], [[vomiting]] | ||
*UTI or pyelonephritis symptoms not improving with antibiotics | *UTI or pyelonephritis symptoms not improving with antibiotics | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[UTI]] | *[[UTI]] | ||
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*[[Renal cyst]] | *[[Renal cyst]] | ||
*[[Renal cancer]] | *[[Renal cancer]] | ||
==Diagnosis== | ==Diagnosis== | ||
*Labs | *Labs | ||
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***Well-defined hypoechoic lesion with thick walls and usually with internal debris | ***Well-defined hypoechoic lesion with thick walls and usually with internal debris | ||
**CT | **CT | ||
==Management== | ==Management== | ||
*Antibiotics | *[[Antibiotics]] | ||
**Broad spectrum if unclear source | **Broad spectrum if unclear source | ||
***If urinary source cover typical urinary pathogens | ***If urinary source cover typical urinary pathogens | ||
****Ceftriaxone 1g IV | ****[[Ceftriaxone]] 1g IV | ||
****Piperacillin-Tazobactam 4.5 g IV | ****[[Piperacillin-Tazobactam]] 4.5 g IV | ||
***If hematogenous spread considered, cover for MSSA and MRSA | ***If hematogenous spread considered, cover for MSSA and MRSA | ||
**** | ****[[Vancomycin]] 15-20 mg/kg IV | ||
*Percutaneous drainage | *Percutaneous drainage | ||
*Open surgical management if pt fails antibiotics/percutaneous drainage | *Open surgical management if pt fails antibiotics/percutaneous drainage | ||
==Disposition== | ==Disposition== | ||
*Admission for IV antibiotics and drainage | *Admission for IV [[antibiotics]] and drainage | ||
**Especially if elderly or elevated BUN or creatinine | **Especially if elderly or elevated BUN or creatinine | ||
==Complications== | ==Complications== | ||
*Need for open surgical management or nephrectomy | *Need for open surgical management or nephrectomy | ||
*Renal failure | *Renal failure | ||
*Sepsis, bacteremia | *[[Sepsis]], bacteremia | ||
*Emphysematous kidney | *Emphysematous kidney | ||
*Cortical abscesses can rupture and form perinephric abscesses | *Cortical abscesses can rupture and form perinephric abscesses | ||
==References== | ==References== | ||
*Dembry LM, Andriole VT. “Renal and Perirenal Abscesses” Infectious Disease Clinics North America: 11, 3, (Sept 1997). | *Dembry LM, Andriole VT. “Renal and Perirenal Abscesses” Infectious Disease Clinics North America: 11, 3, (Sept 1997). | ||
Revision as of 11:52, 24 November 2015
Background
- Rare clinical entity which can lead to delayed diagnosis
- Usually a complication of a UTI or pyelonephritis
- Most commonly due to E. Coli, Klebsiella, Proteus
- Less often can be due to hematogenous spread from other sources of infection
- Most commonly due to Staph aureus
Risk Factors
- Inadequately treated or delayed treatment of UTI or pyelonephritis
- Diabetes
- Renal calculi
- Ureteral obstruction
- Any underlying urinary tract abnormality
- Immunosuppression
Clinical Features
- Costovertebral, flank, lumbar, lower chest, or back pain
- Usually unilateral
- Fever, especially if prolonged or after antibiotic initiation
- Nausea, vomiting
- UTI or pyelonephritis symptoms not improving with antibiotics
Differential Diagnosis
Diagnosis
- Labs
- CBC, BMP, UA, lactate
- Urine culture, blood cultures
- Some studies have shown up to 66% will have + blood cultures
- Imaging
- US
- Well-defined hypoechoic lesion with thick walls and usually with internal debris
- CT
- US
Management
- Antibiotics
- Broad spectrum if unclear source
- If urinary source cover typical urinary pathogens
- Ceftriaxone 1g IV
- Piperacillin-Tazobactam 4.5 g IV
- If hematogenous spread considered, cover for MSSA and MRSA
- Vancomycin 15-20 mg/kg IV
- If urinary source cover typical urinary pathogens
- Broad spectrum if unclear source
- Percutaneous drainage
- Open surgical management if pt fails antibiotics/percutaneous drainage
Disposition
- Admission for IV antibiotics and drainage
- Especially if elderly or elevated BUN or creatinine
Complications
- Need for open surgical management or nephrectomy
- Renal failure
- Sepsis, bacteremia
- Emphysematous kidney
- Cortical abscesses can rupture and form perinephric abscesses
References
- Dembry LM, Andriole VT. “Renal and Perirenal Abscesses” Infectious Disease Clinics North America: 11, 3, (Sept 1997).
- Getting GK, Shaikh N. “Renal Abscess” Journal of EM: 31, 1 (2006): 99-100.
- Tintinalli Judith E, Stapczynski J. Stephan. "Urinary Tract Infections” Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011. 632.
- Yen DHT, et al. “Renal Abscess: Early Diagnosis and Treatment” Am J EM: 17, 2 (March 1999).
- Shu T, Green JM, Orihuela E. “Renal and Perirenal Abscesses in Patients with Otherwise Anatomically Normal Urinary Tracts” Journal of Urology: 172 (July 2004): 148-150.
- http://www.ncbi.nlm.nih.gov/pubmed/16798166