Perinephric abscess: Difference between revisions
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==Background== | ==Background== | ||
[[File:Blausen 0592 KidneyAnatomy 01.png|thumb|Renal anatomy.]] | |||
* | [[File:PMC5265200 13244 2016 536 Fig1 HTML.png|thumb|Perinephric space with exaggerated pararenal space to show retroperitoneal structures. Perinephric bridging septa are seen between the left kidney and the adjacent renal fascia.]] | ||
*An [[abscess]] of the perinephric fat that abuts the renal cortex | |||
*Can arise as a complication either a pre-existing [[pyelonephritis]] (majority) or from hematogenous seeding | |||
===Causative Organisms<ref>Liu XQ, et al. Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study. World Journal of Nephrology. 2016 Jan;5(1):108-14.</ref>=== | |||
*[[E. coli]] (51.4%) | |||
*[[S. aureus]] (10%) | |||
{{Perinephric vs Renal Abscess}} | |||
{{UTI types}} | |||
==Clinical Features== | ==Clinical Features== | ||
*Sign/symptoms similar to [[pyelo]] ([[fever]], CVAT, dysuria) | *Sign/symptoms similar to [[pyelo]] ([[fever]], CVAT, dysuria) | ||
*Occurs in setting of ascending infection with obstructed pyelo | *Occurs in setting of ascending infection with obstructed [[pyelo]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Dysuria DDX}} | {{Dysuria DDX}} | ||
== | ==Evaluation== | ||
===Laboratory Testing=== | |||
*CBC - Although it is a non-specific finding, a leukocytosis is typically seen. | |||
*Chemistry Panel - Lactic acidosis is a common finding and is seen earlier in the disease course in diabetic patients. Renal insufficiency is also commonly seen as well. | |||
*[[Urinalysis]] - Will often show evidence of pyelonephritis, however if the perinephric [[abscess]] is secondary to hematogenous spread, the urine could be sterile. Therefore a negative U/A does NOT rule out a perinephric abscess. | |||
*Blood and urine cultures | |||
===Imaging=== | |||
*CT | |||
**Imaging modality of choice | |||
**Sensitivity ~90%. | |||
*[[Renal ultrasound]] - A fluid filled mass extending from the renal cortex into the perinephric fat can be seen. | |||
==Management== | ==Management== | ||
*[[Antibiotic therapy]] depends on the suspected cause | |||
**[[Pyelonephritis]] (enterobacteriaceae): third generation [[cephalosporin]] + [[quinolone]] | |||
**Hematogenous ([[staphylococcus]])): [[vancomycin]] | |||
**Known to be colonized by [[ESBL]]: [[carbapenem]] | |||
*Abscess drainage | |||
**Abscess of ANY size requires IR for percutaneous drainage | |||
**If any urological obstruction is suspected ([[nephrolithiasis]], [[ureterolithiasis]], external compression from abdominal cavity, presence of pre-existing ureteral stent), emergent urological consultation should be obtained | |||
==Disposition== | ==Disposition== | ||
*Admission | |||
==See Also== | ==See Also== | ||
*[[pyelonephritis]] | |||
*[[Emphysematous pyelonephritis]] | |||
*[[Renal abscess]] | |||
*[[Urolithiasis]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Renal]] | [[Category:Renal]] | ||
[[Category:Urology]] | [[Category:Urology]] | ||
[[Category:ID]] |
Latest revision as of 11:18, 2 May 2020
Background
- An abscess of the perinephric fat that abuts the renal cortex
- Can arise as a complication either a pre-existing pyelonephritis (majority) or from hematogenous seeding
Causative Organisms[1]
Perinephric vs renal abscess
Perinephric | Renal | |
Necrotic Area | Perinephric fat between the renal cortex and Gerota's fascia | Renal parenchyma |
Cause | Pyelonephritis (majority) | Pyelonephritis (vast majority) |
Risk of morbidity | Higher | Lower |
Genitourinary infection
"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.
- Renal/perirenal
- Ureteral
- Infected urolithiasis
- Bladder
- Acute cystitis ("UTI")
- Chronic cystitis
- Urethra/periurethra
Clinical Features
- Sign/symptoms similar to pyelo (fever, CVAT, dysuria)
- Occurs in setting of ascending infection with obstructed pyelo
Differential Diagnosis
Dysuria
- Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
- Nephrolithiasis
- Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
- Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Pelvic organ prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Interstitial cystitis
- Behavioral symptom without detectable pathology
Evaluation
Laboratory Testing
- CBC - Although it is a non-specific finding, a leukocytosis is typically seen.
- Chemistry Panel - Lactic acidosis is a common finding and is seen earlier in the disease course in diabetic patients. Renal insufficiency is also commonly seen as well.
- Urinalysis - Will often show evidence of pyelonephritis, however if the perinephric abscess is secondary to hematogenous spread, the urine could be sterile. Therefore a negative U/A does NOT rule out a perinephric abscess.
- Blood and urine cultures
Imaging
- CT
- Imaging modality of choice
- Sensitivity ~90%.
- Renal ultrasound - A fluid filled mass extending from the renal cortex into the perinephric fat can be seen.
Management
- Antibiotic therapy depends on the suspected cause
- Pyelonephritis (enterobacteriaceae): third generation cephalosporin + quinolone
- Hematogenous (staphylococcus)): vancomycin
- Known to be colonized by ESBL: carbapenem
- Abscess drainage
- Abscess of ANY size requires IR for percutaneous drainage
- If any urological obstruction is suspected (nephrolithiasis, ureterolithiasis, external compression from abdominal cavity, presence of pre-existing ureteral stent), emergent urological consultation should be obtained
Disposition
- Admission
See Also
External Links
References
- ↑ Liu XQ, et al. Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study. World Journal of Nephrology. 2016 Jan;5(1):108-14.