Renal and perinephric abscess
- Alain Meyrier, MD
Alain Meyrier, MD
- Professor of Medicine (Emeritus)
- Université Paris-Descartes, Paris, France
Renal and perinephric suppurations (or abscesses) commonly share similar clinical manifestations, but their pathophysiology, complications, and treatment are not identical.
The clinical manifestations, diagnosis, and management of renal and perinephric abscesses will be reviewed here. Complicated pyelonephritis in general, emphysematous pyelonephritis, malakoplakia, and xanthogranulomatous pyelonephritis are discussed in detail separately. (See "Acute complicated cystitis and pyelonephritis" and "Emphysematous urinary tract infections" and "Xanthogranulomatous pyelonephritis".)
PATHOGENESIS AND MICROBIOLOGY
Renal and perirenal abscesses can complicate a urologic infection (usually due to gram-negative enteric bacilli or a polymicrobial infection) [1-4] or occur secondary to hematogenous seeding (mostly due to Staphylococcus aureus). As an example, in a retrospective study from China that included 98 patients with renal or perinephric abscesses over a 10-year period, the main causative pathogens were Escherichia coli (51.4 percent), S. aureus (10.0 percent), and Klebsiella pneumoniae (8.6 percent) .
Renal abscess occurs more frequently than perinephric abscess. Both start with tissue necrosis (lobar necrosis in renal abscess; perirenal fat necrosis in perinephric abscess). Renal abscess forms a walled-off cavity; perinephric abscess consists of a more diffuse liquefaction located between the renal capsule and Gerota’s fascia. Septation of the perinephric abscess is frequent, which makes drainage more difficult than that of renal abscess.
Renal abscess — Focal renal abscesses typically occur in the setting of generalized pyelonephritis, particularly in patients with anatomical abnormalities that predispose to infection. As an example, approximately two-thirds of renal abscesses caused by gram-negative organisms occur in patients with a renal stone or vesicoureteral reflux . In such cases, the kidney may have suffered previous episodes of infection and be chronically pyelonephritic and scarred.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Yen DH, Hu SC, Tsai J, et al. Renal abscess: early diagnosis and treatment. Am J Emerg Med 1999; 17:192.
- Fair WR, Higgins MH. Renal abscess. J Urol 1970; 104:179.
- Siroky MB, Moylan R, Austen G Jr, Olsson CA. Metastatic infection secondary to genitourinary tract sepsis. Am J Med 1976; 61:351.
- Saiki J, Vaziri ND, Barton C. Perinephric and intranephric abscesses: a review of the literature. West J Med 1982; 136:95.
- Liu XQ, Wang CC, Liu YB, Liu K. Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study. World J Nephrol 2016; 5:108.
- Hill GS. Renal infection. In: Uropathology, 1st Ed, Hill GS (Ed), Churchill Livingstone, New York 1989; 33.
- Dembry LM, Andriole VT. Renal and perirenal abscesses. Infect Dis Clin North Am 1997; 11:663.
- Hoverman IV, Gentry LO, Jones DW, Guerriero WG. Intrarenal abscess. Report of 14 cases. Arch Intern Med 1980; 140:914.
- Lee BK, Crossley K, Gerding DN. The association between Staphylococcus aureus bacteremia and bacteriuria. Am J Med 1978; 65:303.
- Meyrier A, Condamin MC, Fernet M, et al. Frequency of development of early cortical scarring in acute primary pyelonephritis. Kidney Int 1989; 35:696.
- Graves RC, Parkins LE. Carbuncle of the kidney. J Urol (Baltimore) 1970; 104:179.
- Anderson KA, McAninch JW. Renal abscesses: classification and review of 40 cases. Urology 1980; 16:333.
- Coelho RF, Schneider-Monteiro ED, Mesquita JL, et al. Renal and perinephric abscesses: analysis of 65 consecutive cases. World J Surg 2007; 31:431.
- Shu T, Green JM, Orihuela E. Renal and perirenal abscesses in patients with otherwise anatomically normal urinary tracts. J Urol 2004; 172:148.
- Lee BE, Seol HY, Kim TK, et al. Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases. Korean J Intern Med 2008; 23:140.
- Fowler JE Jr, Perkins T. Presentation, diagnosis and treatment of renal abscesses: 1972-1988. J Urol 1994; 151:847.
- Hutchison FN, Kaysen GA. Perinephric abscess: the missed diagnosis. Med Clin North Am 1988; 72:993.
- Sheinfeld J, Erturk E, Spataro RF, Cockett AT. Perinephric abscess: current concepts. J Urol 1987; 137:191.
- Tsukagoshi D, Dinkovski B, Dasan S, Jethwa J. Perinephric abscess secondary to a staghorn calculus presenting as a subcutaneous abscess. CJEM 2006; 8:285.
- Demertzis J, Menias CO. State of the art: imaging of renal infections. Emerg Radiol 2007; 14:13.
- Bova JG, Potter JL, Arevalos E, et al. Renal and perirenal infection: the role of computerized tomography. J Urol 1985; 133:375.
- Kaplan DM, Rosenfield AT, Smith RC. Advances in the imaging of renal infection. Helical CT and modern coordinated imaging. Infect Dis Clin North Am 1997; 11:681.
- Huang JJ, Sung JM, Chen KW, et al. Acute bacterial nephritis: a clinicoradiologic correlation based on computed tomography. Am J Med 1992; 93:289.
- Gerzof SG, Gale ME. Computed tomography and ultrasonography for diagnosis and treatment of renal and retroperitoneal abscesses. Urol Clin North Am 1982; 9:185.
- Reese JH, Anderson RU, Friedland G. Splenic abscess arising by direct extension from a perinephric abscess. Urol Radiol 1990; 12:91.
- Rollino C, Beltrame G, Ferro M, et al. Acute pyelonephritis in adults: a case series of 223 patients. Nephrol Dial Transplant 2012; 27:3488.
- Kuligowska E, Newman B, White SJ, Caldarone A. Interventional ultrasound in detection and treatment of renal inflammatory disease. Radiology 1983; 147:521.
- Roberts JA. Etiology and pathophysiology of pyelonephritis. Am J Kidney Dis 1991; 17:1.
- Talner LB, Davidson AJ, Lebowitz RL, et al. Acute pyelonephritis: can we agree on terminology? Radiology 1994; 192:297.
- Rosenfield AT, Glickman MG, Taylor KJ, et al. Acute focal bacterial nephritis (acute lobar nephronia). Radiology 1979; 132:553.
- Kobayashi A, Utsunomiya Y, Kono M, et al. Malakoplakia of the kidney. Am J Kidney Dis 2008; 51:326.
- Stanton MJ, Maxted W. Malacoplakia: a study of the literature and current concepts of pathogenesis, diagnosis and treatment. J Urol 1981; 125:139.
- van Crevel R, Curfs J, van der Ven AJ, et al. Functional and morphological monocyte abnormalities in a patient with malakoplakia. Am J Med 1998; 105:74.
- Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics 2008; 28:255.
- Meng MV, Mario LA, McAninch JW. Current treatment and outcomes of perinephric abscesses. J Urol 2002; 168:1337.
- Lang EK. Renal, perirenal, and pararenal abscesses: percutaneous drainage. Radiology 1990; 174:109.
- Deyoe LA, Cronan JJ, Lambiase RE, Dorfman GS. Percutaneous drainage of renal and perirenal abscesses: results in 30 patients. AJR Am J Roentgenol 1990; 155:81.
- Lee SH, Jung HJ, Mah SY, Chung BH. Renal abscesses measuring 5 cm or less: outcome of medical treatment without therapeutic drainage. Yonsei Med J 2010; 51:569.
- Siegel JF, Smith A, Moldwin R. Minimally invasive treatment of renal abscess. J Urol 1996; 155:52.
- Dalla Palma L, Pozzi-Mucelli F, Ene V. Medical treatment of renal and perirenal abscesses: CT evaluation. Clin Radiol 1999; 54:792.
- PATHOGENESIS AND MICROBIOLOGY
- Renal abscess
- Perinephric abscess
- Risk factors
- CLINICAL MANIFESTATIONS
- Symptoms and physical findings
- Laboratory findings
- Radiographic findings
- DIAGNOSIS AND EVALUATION
- Microbiological diagnosis
- Other laboratory tests
- DIFFERENTIAL DIAGNOSIS
- - Empiric therapy
- - Directed therapy and duration
- - Renal abscess
- - Perinephric abscess
- Urologic/surgical intervention
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS