Perinephric Abscess Research Articles

Late and Rare Complications of Urolithiasis: Perinephric Abscess and Renal Replacement Lipomatosis

Background: Perinephric abscess and renal replacement lipomatosis (RRL) as a late and rare complications of urolithiasis.Case presentation: We report the case of a 62-year-old Kazakh woman who suffered for a long period of time from back pain,weakness (has been treated with confirmed osteochondrodystrophy) and was not aware about her kidney stones. She hadnever had hematuria or renal colic and urgently was admitted in a serious condition with large palpable abdominal mass. Thediagnostic workup, differential diagnosis, surgical management, medical follow-up and a review of the literature presented.Persistent back pain and weakness for several years were caused by nephrolithiasis and its late and rare complications likeRRL. Only one of the acute complications of nephrolithiasis as perinephric abscess attracted the attention of urologists andmade it possible to set up the correct diagnosis. Surgical management of the hephrolithiasis complications (urgent drainage ofperinephric abscess and delayed nephrectomy [because nonfunctioning kidney with multiple stones as a nidus of infectionsand RRL] after stabilization of patient’s condition was performed.Conclusion: Occasionally urolithiasis may mimic signs of spine disease, so in patients with persistent back pain which did notrespond to conventional therapy of this pathology should be excluded the hephrolithiasis. Non-treated urolithiasis may lead toloss of the kidney function and development of life-threatening acute complications like perinephric abscess and later – renalreplacement lipomatosis.

NEPHRO-PLEURAL ABSCESS SECONDARY TO MRSA

SESSION TITLE: Chest Infections 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: It is not uncommon to have pleural effusions secondary to subdiaphragmatic pathology due to an intrabdominal process. However, pleural suppurative infections caused by direct communication between intraabdominal abscesses and the thoracic cavity is extremely rare. We present a unique case of a female diagnosed with a perinephric abscess extending into the pleural space causing an empyema. CASE PRESENTATION: A 45-year-old female with known history of Moya Moya and intravenous drug use presented with left flank pain and shortness of breath of three weeks duration. On presentation she was notable for fever, tachycardia, tachypnea, and hypoxia requiring supplemental oxygenation. Her physical examination revealed diminished breath sounds on the left and left flank tenderness. Her laboratory tests were significant for a leukocytosis with a neutrophil predominance and were otherwise within normal limits. Her urinalysis was negative for white blood cells, nitrites, and bacteria. Blood and urine cultures were also negative. Chest x-ray revealed a left sided effusion, and a subsequent computed tomography of the abdomen and pelvis revealed a left 5x4x3 suprarenal abscess that extended superiorly into the intrathoracic space. She was empirically treated with vancomycin and piperacillin-tazobactam. A thoracentesis was performed and pleural fluid studies demonstrated an exudative effusion with a pH of 7.13. A chest tube was inserted for management of the empyema and was further treated with consecutive doses of tPA and Dornase. Antibiotics were tailored to linezolid once pleural fluid cultures were positive for MRSA. The patient continued to clinically improve, and the chest tube was removed as the effusion diminished and drainage decreased. The patient was discharged home with a six week course of linezolid and close follow up. Repeat abdominal imaging noted improvement of the pleural effusion and decrease in abscess size. DISCUSSION: The majority of nephro-pleural fistulas are formed in patients with nephrolithiasis. An empyema formed secondary to an intrabdominal abscess, such as this case, is extremely rare and is likely secondary to a fistula formation. Due to our patient's delayed presentation and history of drug abuse she suffered from a MRSA abscess complicated by a potential fistulous track leading to a concomitant empyema. CONCLUSIONS: The significance of this case is to increase awareness that chronic untreated intrabdominal abscesses may develop into an intrathoracic infection. Management typically consists of evacuation and a prolonged course of antibiotics. Reference #1: Jones GH, Kalaher HR, Misra N, Curtis J, Parker RJ. Empyema and Respiratory Failure Secondary to Nephropleural fistula Caused by Urinary Tract Infection: A Case Report. Case Reports in Pulmonology. 2012; 1-5. https://doi.org/10.1155/2012/595402. DISCLOSURES: No relevant relationships by Said Chaaban, source=Web Response No relevant relationships by Rachel Goodwin, source=Web Response No relevant relationships by Melissa Jordan, source=Web Response

Renal capsulotomy associated with omentopexy for treatment of bilateral perinephric abscess in a bitch: case report

A perinephric abscess is a rare and difficult to treat disease in veterinary medicine. The aim of this paper is to report a case of successful treatment using capsulotomy and omentopexy for bilateral perinephric abscess in a dog.

Papillary Renal Cell Carcinoma Presenting as a Perinephric Abscess

Papillary Renal Cell Carcinoma Presenting as a Perinephric Abscess

Clinical profile and successful outcomes of conservative and minimally invasive treatment of emphysematous pyelonephritis.

IntroductionEmphysematous pyelonephritis (EPN) is a rare clinical entity, characterized by gas in the renal system, due to an acute, fulminant and potentially fatal necrotizing process with varying clinical presentations. It is much more aggressive than uncomplicated pyelonephritis, with the mortality of 20–40% in the contemporary meta-analysis.Material and methodsA retrospective record review of inpatients at the Institute of Nephro Urology, Bangalore, India (2007–2014), who were treated after EPN was diagnosed with the aid of a CT (computed tomography) scan.ResultsSixty-six patients (M:F 27:39) treated for EPN over the past seven years with the mean (±SD) age of 52.32 (±12.48) years were analyzed. Median (interquartile range) duration of hospital stay was 8 (11.25) days with 4 (6%) patients requiring intensive care unit admission (median, IQR = 5.5, 1.5 days) of whom two passed away due to septicemia. Fifty-six (84.85%) patients were diabetics, forty (60.6%) patients had estimated glomerular filtration rate (eGFR) <60 ml/min/1.7 3 m2, 6 (9.1%) patients had eGFR <30 ml/min/1.73 m2 including 3 (4.5%) with eGFR <15 ml/min/1.73 m2 requiring hemodialysis and twenty-two (33%) had thrombocytopenia. Fifty (75.76%) patients were classified as Huang and Tseng Class 2, 7 (10%) as Class 3 with perinephric abscess requiring open drainage and 9 (13.64%) had bilateral EPN (Class 4). Majority (43; 65%) responded to piperacillin-tazobactam treatment. Double J stenting was done in 17 (25.76%) patients, percutaneous drainage in 5 (7.58%) patients and nephrectomy in 2 (3%) patients.ConclusionsAlthough EPN historically carries high morbidity and mortality, modern day medical management with timely intervention in the form of urinary drainage is effective and curative in most patients resulting in a low mortality rate.

Candida Perinephric Abscess: A Rare Presentation in a Trauma Patient

Abstract Background: The perinephric space is a closed anatomic space that plays an important role in limiting and transmitting disease processes. Perinephric abscess is an uncommon complication of...

Abscesos renales en pediatría: reporte de caso

Los abscesos renales y perirrenales hacen parte de un grupo de infecciones poco frecuentes en pediatría que comprometen el parénquima renal y el espacio perinefrítico. Estas entidades no tienen una clínica específica y, por lo tanto, se deben sospechar en todos los pacientes con infección urinaria que no respondan a la terapia antimicrobiana adecuada. De su apropiado diagnóstico dependerá la evolución y el pronóstico del paciente. Si bien el drenaje percutáneo mediante radiología intervencionista es un procedimiento descrito para el tratamiento de esta patología en los adultos, este puede hacer parte del manejo en pediatría. En este artículo, se presenta el caso clínico de un niño de tres años con diagnóstico de absceso renal y su manejo en un centro pediátrico de Bogotá, junto a una revisión actualizada de esta patología.

Major infections in children with nephrotic syndrome

Background: Infections remain an important cause of mortality and morbidity in children with nephrotic syndrome. It triggers the onset of disease or relapses and may also be responsible for a poor response to steroid therapy. Understanding the type and severity of infections is important in the appropriate management of these children. This study was conducted to determine the frequency and type of major infections in children with nephrotic syndrome.Methods: A longitudinal descriptive study was conducted in a tertiary center, in children between 1 and 12 years with nephrotic syndrome satisfying the International Study of kidney disease in children (ISKDC) criteria, from March 2013 to September 2014. Major infections were defined as infections affecting deep organs and tissues which warrant hospitalization. Results: A total of 246 children with nephrotic syndrome were enrolled, of whom 46 children developed 48(19.6%) episodes of major infections. Thirteen (27%) major infections occurred in the initial episode and 35(73%) in relapse cases. Pneumonia (41.7%) was the commonest infection, followed by urinary tract infection (25%), septicemia (16.7%), spontaneous bacterial peritonitis (8.3%), cellulitis (4.2%), perinephric abscess (2.1%) and pulmonary tuberculosis (2.1%). Two children had multiple infections. Methicillin resistant staphylococcus aureus was the causative organism in 5 children with septicemia. A 24% of bacterial isolates were multidrug resistant.Conclusions: Major infections remain an important complication of nephrotic syndrome in children, especially during relapses. Drug resistant organisms should be considered while treating major infections in these children.

Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis.

BackgroundThe objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for developing therapeutic strategies in community-acquired acute pyelonephritis (CA-APN) patients.Materials and MethodsWe prospectively collected the clinical data of CA-APN patients who visited 11 hospitals from March 2010 to February 2011.ResultsPositive urine and blood cultures were obtained in 69.3% (568/820) and 42.7% (277/648), respectively, of a total of 827 CA-APN patients. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients for whom both urine and blood cultures were performed; the organisms isolated from urine were inconsistent with those from blood in 11 and only blood cultures were positive in 49 patients. Final clinical failure was more common in the bacteremic patients than the non-bacteremic ones (8.0% vs. 2.7%, P = 0.003), as was hospital mortality (3.6% vs. 0.3%, P = 0.003). Likewise, durations of hospitalization and fever were significantly longer. Bacteremia was independent risk factor for mortality (OR 9.290, 1.145-75.392, P = 0.037). With regard to radiologic studies, the detection rate of APN was 84.4% (445/527) by abdominal computed tomography and 40% (72/180) by abdominal ultrasonography. Eighty-one of 683 patients (11.9%) were found to have renal abscess, perinephric abscess, urolithiasis, hydronephorosis/hydroureter or emphysematous cystitis, which could potentially impact on clinical management. Patients with Pitt score ≥ 1, flank pain or azotemia were significantly more likely to have such structural abnormalities.ConclusionBlood cultures are clinically useful for diagnosis of CA-APN, and bacteremia is predictive factor for hospital mortality. Early radiologic imaging studies should be considered for CA-APN patients with Pitt scores ≥1, flank pain or azotemia.

1 カ月乳児の腎周囲膿瘍 (perinephric abscess) の治験例

1 カ月乳児の腎周囲膿瘍 (perinephric abscess) の治験例

Isolation of Salmonella typhi from Perinephric Abscess - A Case Report from National Medical Hospital, Karachi

Salmonella typhiis a versatile pathogen with amazing potential of infecting almost all organs of its host. Globally, the life threatening illnesses caused by Salmonella typhihave made this pathogen a serious health concern for infection control professionals. Various microbes have been found associated with intrarenal abscesses that ultimately lead to high morbidity and mortality rates. We are reporting an unusual and rare case of intrarenal abscess caused by Salmonella typhi in a febrile patient admitted to private care hospital in Karachi. Interestingly, the isolated strain was found to be resistant against first line of drugs but showed intermediate pattern towards ciprofloxacin.

Neglected staghorn calculus presenting with perinephric abscess and discharging lumbar sinus-a case report

Neglected staghorn calculus presenting with perinephric abscess and discharging lumbar sinus-a case report

Fungi and diabetes

Fungi and diabetes

Primary adenocarcinoma of the renal pelvis, ureter and the urinary bladder: A case report and review of the literature.

Primary adenocarcinoma is a rare type of urological neoplasm. The present study reports the case of a 55-year-old man with multifocal adenocarcinoma of the renal pelvis, ureter and urinary bladder that occurred in association with a large cystic calculus and perinephric abscess. The patient had suffered from gross hematuria for 2 years and right flank pain for 2 months. Following a series of investigations, a large cystic calculus with multiple tumors in the renal pelvis and ureter was identified. Multifocal tumors and a large calculus were located in the bladder using a cystoscope. The pathological report of 3 individual biopsies revealed a moderately differentiated tubular adenocarcinoma. Right nephrectomy, ureterectomy, radical cystectomy and left ureterocutaneostomy were performed. The pathological investigation revealed a moderately differentiated adenocarcinoma of the renal pelvis, ureter and urinary bladder. No additional treatment was administered and the patient remains alive at follow-up without disease recurrence or metastasis. Although uncommon, the development of a tumor is possible in patients that possess long-standing urolithiasis, particularly when accompanied by hydronephrosis or infection.

Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study.

To elucidate the clinical, radiological and laboratory profiles of renal abscess (RA) and perinephric abscess (PNA), along with related treatment and outcome. Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identified from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition (ICD-10) codes (RA: N15.101, PNA: N15.102) between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients' characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance profiles, treatment approaches, and clinical outcomes were collected and analyzed. The mean age of the patients was 46.49 years with a male to female ratio of 41:57. Lumbar pain (76.5%) and fever (53.1%) were the most common symptoms. Other symptoms and signs included chills (28.6%), anorexia and vomiting (25.5%), lethargy (10.2%), abdominal pain (11.2%), flank mass (12.2%), flank fistula (2.0%), gross hematuria (7.1%), frequency (14.3%), dysuria (9.2%), pyuria (5.1%) and weight loss (1.0%). Painful percussion of the costovertebral angle (87.8%) was the most common physical finding. The main predisposing factors were lithiasis (48.0%), diabetes mellitus (33.7%) followed by history of urological surgery (16.3%), urinary tract infections (14.3%), renal function impairment (13.3%), liver cirrhosis (2.0%), neurogenic bladder (1.0%), renal cyst (1.0%), hydronephrosis (1.0%), chronic hepatitis B (1.0%), post-discectomy (1.0%) and post-colectomy (1.0%). Ultrasound (US) and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice. Escherichia coli (51.4%), Staphylococcus aureus (10.0%) and Klebsiella pneumoniae (8.6%) were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders. Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.

Brucellosis associated with kidney injury and any form of nephropathy – a review of the literature

Systemic brucellosis may be associated with acute kidney injury (AKI), haemolytic–uraemic syndrome, nephrotic syndrome or various types of nephropathy. Presentation depends on the type of renal disease the patient develops. A diagnosis of brucellosis as a cause of nephropathy would require the following: isolation of Brucella in blood culture; positive serological test for brucellosis; renal biopsy evidence of the type of nephropathy; culture of Brucella from perinephric abscess or renal abscess aspirate; culture of Brucella from nephrectomy specimen; and finding a specific type of nephropathy during histological examination. Ultrasonographic and computerized tomographic findings are not specific for brucellosis; however, the scans may show an abnormal area in the kidney from which renal biopsies can be taken for pathological examination and culturing, and if there is an abscess it can be aspirated for culture. A high index of suspicion is required to diagnose the disease. The most commonly used antibiotic regimen for the treatment for brucellosis is doxycycline 100mg twice a day for 45 days in combination with streptomycin 1g/day for 15 days. The main alternative treatment is doxycycline 100mg twice a day for 45 days in combination with rifampicin 15mg/kg/day (600–900mg) for 45 days. Experience suggests that streptomycin may be replaced by gentamicin 5mg/kg/day for 7–10 days. The optimal treatment for neonates and children under 8 years old with acute brucellosis has not yet been determined but there is some experience with trimethoprim/sulfamethoxazole (cotrimoxazole) in combination with an aminoglycoside (streptomycin, gentamicin) or rifampicin. In general, other combinations of antibiotics have also been used to treat brucellosis. In cases of kidney injury and dehydration, in addition to antibiotic treatment, rehydration and clinical monitoring is required, as is monitoring urine output, repeated urinalysis and repeated serum biochemical tests for renal function estimation to assess the patient’s progress. Most renal complications due to brucellosis resolve/improve after combined antibiotic treatment and rehydration, which is also most often associated with return of normal renal function or improvement in renal function. However, relapses can occur, and careful patient follow-up is required to further assess the patient clinically by regularly repeating urinalysis, renal function tests, liver function tests and full blood count and coagulation tests, as well as repeating blood and urine cultures and Brucella serology tests. Patients should be educated to avoid contact with and ingestion of unpasteurized dairy products. Pasteurization of all dairy products should be advised, encouraged and monitored. Veterinary surgeons in endemic areas should be informed and assist when a new diagnosis is made in order to help identify and treat or kill affected animals harbouring Brucella .

Vancomycin-resistant Enterococcus faecium causing perinephric abscess

An 8-month-old infant presented with history of recurrent urinary tract infection and was found to have a perinephric abscess on investigation. Enterococcus faecium resistant to Vancomycin and sensitive to Linezolid was obtained from the baby's urine and perinephric collection. The patient was treated successfully with Linezolid. This case report describes the emergence of Vancomycin-resistant enterococc in this hospital.

Emphysematous Pyelitis Disguised as Cholestasis and Jaundice

Emphysematous pyelitis is a rare infection of the renal pelvis occurring alone or in association with pyelonephritis. The most common cause is E. coli and diabetes is the strongest risk factor. In a retrospective review including 48 patients who were diagnosed with either emphysematous pyelitis or pyelonephritis, the mean patient age was 60 years old and women outnumbered men 6:12. The most common initial symptoms include fever, dysuria, abdominal pain, and flank pain. The most frequent organ system involvement is hematologic and renal. Our patient, a 76 year old female, with no past medical history, presented with progressive weakness followed by the onset of jaundice. Her exam was notable for hypertension but no fever, jaundice, epigastric/right upper quadrant abdominal tenderness or peritoneal signs. Labs were remarkable for a profound leukocytosis, anemia, cholestasis, and an elevated creatinine. An abdominal ultrasound did not reveal cholecystitis or a common bile duct obstruction. Empiric antibiotics to include Ceftriaxone and Flagyl were started for possible cholangitis. On hospital day two, an abdominal endoscopic ultrasound was performed in lieu of a contrast study as renal function had worsened. This examination was normal. A non-contrasted CT scan of the abdomen and pelvis demonstrated the unusual findings of emphysematous pyelitis with a surrounding fluid collection concerning for a perinephric abscess. Subsequent management included placement of a percutaneous nephrostomy tube and antibiotics. Emphysematous pyelitis presenting as cholestasis is a novel clinical presentation of a rare illness.

Renal Squamous Cell Carcinoma of a Native Kidney After Renal Transplant: A Case Report

BackgroundRenal squamous cell carcinoma is a rare primary tumor of the kidney that rapidly invades local structures and has a poor prognosis. Presentation is usually nonspecific and is associated with renal stone disease and chronic infection. Immunosuppressed renal transplant recipients are more likely to develop a malignancy than the general population. Squamous cell carcinoma of the kidney in the context of a renal transplant and long-term immunosuppression has not previously been described in the literature. Case ReportA 46-year-old white man with previous renal stones and recurrent urinary infections underwent a right nephrectomy and subsequent renal transplantation owing to failure of the remaining kidney. Five years posttransplant, an abdominal ultrasound scan was performed owing to recurrent urinary infections and ongoing pyuria. This was reported as normal, but he later developed a discharging sinus in his left flank. A computed tomography (CT) scan revealed a tracking perinephric abscess with an associated cystic lesion of the left kidney. A left nephrectomy was performed and histologic examination suggested an invasive squamous cell carcinoma of the renal pelvis. The patient later required major surgery for chronic infection, and further imaging revealed metastatic disease, resulting in the decision to manage palliatively. ConclusionGiven the nonspecific nature of the symptoms and the poor prognosis, health care professionals should have a lower threshold for diagnostic imaging in these patients. Abdominal ultrasonography was unhelpful and only a later CT scan revealed the underlying malignancy. This should be expedited if there is a persistent abnormality on urinalysis. Once diagnosed, a change in immunosuppressant regime to include sirolimus should be considered.

Beethoven's autopsy revisited: A pathologist sounds a final note.

This review of the original autopsy report of Beethoven's remains indicates Paget's disease within the skull, which was dense and twice normal thickness, with dilated vessels at the petrous bone. The facial nerves were enlarged and the eighth nerves atrophied despite their sharing a common meatus at the internal auditory canal. Nephrolithiasis and pyelonephritis with cortical and perinephric abscesses were also reported. The hypercalcaemia was probably caused by hyperparathyroidism, which may be associated with Paget's disease, and both may have played a role in his psychiatric symptoms as well as in his abdominal pain and gastrointestinal complaints. Since Paget's disease may also be associated with gout, some of the joint pains could be attributable to this as well. Hypovitaminosis A from chronic pancreatitis is suggested as a cause of painful eyes and either quinine abuse or severe hypercalcaemia as a cause of arrhythmias. Beethoven died of terminal cirrhosis with chronic pancreatitis, most likely related to chronic excessive intake of alcohol. Thus, Paget's disease, complicated by hyperparathyroidism, gout, and attempts to find relief of symptoms through the use of alcohol, quinine, and possibly salicylates can explain virtually all of Beethoven's medical problems, some of which appear to have influenced his musical compositions.