Renal abscess 1 Introduction Abscess in the renal

Renal abscess 1

Introduction • Abscess in the renal parenchyma • Also known as the carbuncle of the kidney • Etiology: – Staphylococcus aureus: released from distance sources – Injury to the kidney – E. coli 2

Clinical features • Symptoms: fever, chills, loin pain • Signs: – extreme tenderness over the affected kidney 3

Investigations • Blood: elevated WBC • Urine: – usually negative in the early stages – Pus cells & bacteria if the abscess ruptures into the renal pelvis • Straight X- ray: enlarged kidney • IVU: space occupying lesion obliterating or compressing a group of calyces &/ or a part of the pelvis of the ureter 4

36 -year-old man with left renal abscess. Longitudinal gray-scale sonogram of left kidney shows welldefined hypoechoic mass (arrow) near mid region of kidney. 5

Nonenhanced CT scan through the mid pole of the right kidney demonstrates right renal enlargement 6 and an area of decreased attenuation

A, Enhanced CT scan shows an irregular septated low-density mass (M) extensively involving the left kidney. Note thickening of perinephric fascia) and extensive compression of the renal collecting system. Findings are typical of renal abscess. B, Ultrasound longitudinal scan demonstrates a septated hypoechoic mass (M) occupying much of the renal parenchymal volume 7

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Treatment • Antibiotics • Surgical drainage • Nephrectomy 9

Perinephric abscess 10

Introduction • Abscess between the renal capsule & the perirenal fascia of Gerota 11

Etiology • Primary: hematogenous • Secondary: – Infection travels from neighboring organs – Usually follows renal abscess – Infection of a perirenal hematoma 12

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Clinical features • Symptoms: typical history of prolonged urinary infection, fever, pain in the flank • Signs: fever, marked tenderness over the kidney, scoliosis of the spine 14

Investigations • Blood: leukocytosis, anemia • Urine: – Pyuria & bacteriuria • Straight X- ray: – Obliteration of the renal & psoas shadow – Scoliosis of the spine • IVU: Mathe’s sign • Isotope scanning 15

Treatment • Antibiotics • Surgical drainage 16