Overview
Renal and perinephric abscesses are localized collections of pus involving the kidney or the surrounding retroperitoneal space, often complicating urinary tract infections or calculi. 2Diagnosis
Clinical signs include fever, flank pain, and palpable mass.
Imaging studies (CT, ultrasound) are essential for diagnosis and to assess extent and complications 2.
Culture of aspirated pus is crucial for identifying causative organisms and guiding antibiotic therapy 2.Management
First-line treatment: Intravenous antibiotics targeting identified pathogens, often including broad-spectrum coverage initially 2.
Drainage: Percutaneous drainage is a common approach, but surgical intervention may be necessary for complex cases or failures 12.
Adjunctive therapies: Close monitoring for complications such as fistulas (e.g., reno-splenic) and ensuring adequate fluid resuscitation 2.Special Populations
Comorbidities: Patients with implanted devices (e.g., baclofen pump) require careful planning for percutaneous procedures to avoid complications 1.
Positioning and anesthesia: Special considerations for patients with spinal cord injuries to safely perform imaging-guided interventions 1.Key Recommendations
Use imaging (CT, ultrasound) for accurate diagnosis and assessment of abscess extent (Evidence: Moderate 2).
Initiate intravenous broad-spectrum antibiotics tailored to culture results (Evidence: Moderate 2).
Consider percutaneous drainage under appropriate sedation for feasible cases, with caution in patients with implanted devices (Evidence: Weak 1).References
1 Vaidyanathan S, Soni BM, Hughes PL, Singh G, Watt JW, Oo T et al.. How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall? - A case report. BMC urology 2002. link
2 Stewart IE, Borland C. Case report: perinephric-splenic fistula--a complication of percutaneous perinephric abscess drainage. The British journal of radiology 1994. link