Perirenal Abscess Research Articles

A case of refractory urinary fistula after partial nephrectomy treated with additional partial nephrectomy for suspected isolated calix

Introduction: Urinary fistula is the major complication after partial nephrectomy and is occasionally refractory to conservative treatments. Case Report: A 66-year-old man with renal cell carcinoma was treated with partial nephrectomy. Diagnosis of urinary fistula was triggered by drainage of perirenal abscess after surgery. Being refractory to ureteral stenting, a dilated ventral upper calix was detected in the subsequent fistulography, whereas the calix or its connection with the renal pelvis was not demonstrated in excretion phase of enhanced computed tomography. Considering the possibility of isolated calix due to infundibular injury besides the fistula communicating with the renal pelvis, we performed additional partial nephrectomy for the upper pole kidney and immediately closed the collecting system. The drain could be removed thereafter. Conclusion: We report the first case of refractory urinary fistula after partial nephrectomy treated with additional partial nephrectomy.

A Case Report on Perinephric Abscess Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae

Perinephric abscess is a rare life-threatening condition. It can complicate a urologic infection or occur secondary to hematogenous seeding. We report a case of a 49-year-old diabetic female who came to the outpatient department with complaints of right-sided abdominal pain for 2 days. It was associated with fever, headache, vomiting, and generalized weakness. Non-contrast computerized Tomography (NCCT) showed a subcapsular collection measuring 6.1× 5.7 × 4.4 cm noted adjacent to the lateral aspect of the right kidney. Following percutaneous nephrostomy, thick pus was drained from the abscess and sent for culture and sensitivity in the microbiology laboratory. Culture grew extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae which was sensitive to Carbapenems, Piperacillin Tazobactam, Fluoroquinolones, Netilmicin, Amikacin, and Tetracycline. The patient improved on treatment with the appropriate antibiotics. Perinephric abscesses should be considered as a differential diagnosis of fever with abdominal pain or flank pain since its non-specific nature can delay the diagnosis. Underlying diabetes mellitus (DM), urinary tract abnormalities, and immunodeficiency should be considered in a patient with a perinephric abscess. Ultrasonography (USG) and Computerized Tomography with contrast enhancement are crucial for diagnosis. The drainage of the abscess, either percutaneous or open, should be done. Klebsiella pneumoniae is a frequent cause of perinephric abscesses and mostly follows a complicated urinary tract infection. With high mortality rates, early diagnosis, and effective treatment of perirenal abscesses are required to improve the prognosis of patients.

Is conservative management safe in patients with acute ureterolithiasis and perirenal stranding?

In patients presenting with ureterolithiasis, perirenal stranding is frequently observed in non-contrast computed tomography. Because perirenal stranding may be caused by tears in the collecting system, previous studies have described an increased risk of infectious complications and suggested broad empiric antibiotic therapy and immediate decompressing of the upper urinary tract. We hypothesized that these patients can also be managed conservatively. Therefore, we retrospectively identified patients with ureterolithiasis and perirenal stranding and compared diagnostic and treatment characteristics as well as treatment outcomes between patients undergoing conservative versus interventional management by ureteral stenting, percutaneous drainage or primary ureteroscopic stone removal. We classified perirenal stranding as mild, moderate or severe based on its radiological extent. Of 211 patients, 98 were managed conservatively. Patients in the interventional group had larger ureteral stones, more proximal ureteral stone location, more severe perirenal stranding, higher systemic and urinary infectious parameters, higher creatinine levels, and received more frequent antibiotic therapy. The conservatively managed group experienced a spontaneous stone passage rate of 77%, while 23% required delayed intervention. In the interventional and conservative groups, 4% and 2% of patients, respectively, developed sepsis. None of the patients in either group developed a perirenal abscess. Comparison of perirenal stranding grade between mild, moderate and severe in the conservatively treated group showed no difference in the spontaneous stone passage and infectious complications. In conclusion, conservative management without prophylactic antibiotics for ureterolithiasis and perirenal stranding is a valid treatment option as long as no clinical or laboratory signs of renal failure or infections are observed.

PERCUTANEOUS DRAINAGE AS AN ALTERNATIVE OF SURGICAL MANAGEMENT IN PARARENAL ABSCESS: A CASE REPORT

Objective: This case report will discuss the experience of using percutaneous drainage as an alternative of open surgery in pararenal abscess therapy. Case(s) Presentation: 61 years old woman complained of left flank pain 6 months before with septic condition. Physical examination revealed tenderness and mass in the left flank region with leukocytosis. Abdominal Computed Tomography (CT) Scan results showed a left lower pole pararenal abscess, severe hydropyonephrosis and ureteropelvic junction stones. Percutaneous abscess drainage and percutaneous nephrostomy was performed with an 18Fr troicart using ultrasound guidance. Discussion: The pus culture showed Escherichia coli bacteria. After three days of operation and intravenous antibiotics, the patient experienced clinical improvement. Outpatient follow-up showed decreased drain production from percutaneous abscess drainage and clear yellow liquid production from percutaneous. Percutaneous nephrolithotomy was performed for the management of stone evacuation. After going through the whole procedure, there is clinical improvement of patient. Conclusion: Percutaneous drainage is an alternative option in the management of perirenal abscesses. Compared to open surgical drainage, the percutaneous technique provides a minimally invasive process, shorter length of stay and more effective costs. This procedure has also shown good clinical improvement in patients.
 Keywords: Minimal invasive, pararenal abscess, percutaneous drainage.

394: A CASE OF EXTENSIVE NECROTIZING FASCIITIS DUE TO STRING TEST-NEGATIVE KLEBSIELLA PNEUMONIAE

Introduction: Monomicrobial Klebsiella pneumoniae necrotizing fasciitis is rare in North America. The strain that causes necrotizing fasciitis is thought to be hypermucoviscous or hypervirulent K. pneumoniae (hvKP). hvKP is responsible for increasing numbers of cases within the US due to the prevalence of travel and immigration. Description: A 57-year-old Caucasian female with diabetes and history of IV drug use presented to the emergency room with 3 days of left calf pain. Venous doppler was negative for DVT. She was discharged home with medication for musculoskeletal pain. Eleven days later, she returned with worsening left lower extremity pain, edema, and weakness. Physical exam revealed left lower extremity tenderness to palpation and crepitus with scars from drug injections. The laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 9, indicating high suspicion for necrotizing fasciitis. X-ray of the tibia-fibula and femur revealed subcutaneous gas. Broad spectrum antibiotics were initiated, and the patient underwent emergent surgical debridement. Despite aggressive surgical intervention, she continued to worsen with increasing vasopressor requirements due to septic shock. Imaging of the abdomen and pelvis showed extension of the necrotizing fasciitis. Gas was identified within a complex left perirenal abscess, the epidural space and intervertebral disc space of the lower lumbar spine and sacrum, as well as within the urinary bladder. The patient returned to the operating room for further debridement. Wound, blood, and urine cultures yielded Klebsiella pneumoniae and the lab was directed to perform a string test, which was negative. On hospital day two, she had worsening multiorgan failure, and the family elected to withdraw care. Discussion: hvKP with a negative string test is a unique phenotype that is not well described in the literature. Usually, hvKP is identified by a string test and rarely genotyping. Most cases involve patients of Asian descent or recent travel to Asia. As this patient was Caucasian with no recent travel, we suspect that she contracted the organism through IV drug use. The unique aspects of this case may help us understand this new emerging strain in the US.

Perirenal Abscess in a Patient with Rheumatoid Arthritis.

Perirenal Abscess in a Patient with Rheumatoid Arthritis.

Renal replacement lipomatosis with granulomatous inflammation – A case report and review of literature

Renal replacement lipomatosis can be defined as the proliferation of fibrofatty tissue which subsequently replace the renal parenchyma. It is usually benign unilateral and occurs as a result of severe atrophy or destruction of the renal parenchyma, due to a calculus with secondary proliferation of renal sinus, renal hilus, and perirenal fatty tissue to a variable extent.A 55yr old female presented to surgeon with history ofpain and swelling in right flank. On CECT abdomen there was seen non functional right kidney with staghorn calculi along with perirenal abscess. Patient was treated with nephrectomy and drainage of collection. Intraoperatively Perirenal Abscess extending to psoas and iliopsoas region along with dense adhesion between kidney and liver was found. The multiple sections studied from the lesion showed extensive fibrofatty tissue with few tubule like structures lined by cuboidal epithelium and containing dense eosinophilic secretions. There is seen mixed inflammatory infiltrates with granulomas. Histological features confirmed that Renal replacement lipomatosis with granulomatous inflammation.The clinical importance of RRL is that it stimulates fat-containing tumors in the kidney or its vicinity such as lipomas, angiomyolipomas and liposarcomas can be misdiagnosed preoperatively. Hence this case report has been presented to create awareness of this condition among the pathologist and practicing urosurgeons.

Combined transarterial embolization and percutaneous image-guided ablation for the treatment of T1B and central renal tumors in patients with high surgical risk

Objectives: The objectives of the study were to assess the technical success, efficacy, and complications of the combination of transarterial embolization (TAE) followed by percutaneous ablation in treating stage cT1b and central renal tumors. Material and Methods: An institutional registry was reviewed for patients who underwent TAE followed by percutaneous computed tomography (CT)-guided renal ablation from 2007 to 2018. Twenty-eight consecutive patients (median age 69 years; range 45–89 years) with tumor size ranging from 25 to 58 mm (average 45 mm), including 24 patients with T1b tumors and four with central T1a tumors, were identified. Nineteen patients had TAE followed by cryoablation (CA), and nine patients had TAE followed by radiofrequency ablation (RFA). Technical success, local tumor control, and post-procedure complications were retrospectively reviewed. Results: All procedures were technically successful. Local tumor control was achieved in 26 of 28 patients (92.9%) at a median follow-up of 26 months. Local tumor recurrence was found in two of 28 patients, with a median time to local recurrence of 15 months. The recurrences occurred in one patient who had TAE plus CA and in one patient who had TAE plus RFA. Self-limited hematoma and hematuria were minor complications observed in 3 patients (10.7%). Only one patient had a major complication. This patient developed ureteral obstruction and perirenal abscess requiring ureteral stent and percutaneous drainage without long-term sequela. Conclusion: In this cohort of patients, a combination of TAE and percutaneous CT-guided ablation was an effective, well-tolerated, and safe treatment for patients with T1b and central renal tumors.

Retroperitoneal Abcess Profiles in a Tertiary Hospital in Bandung, Indonesia : Long Term Retrospective Study

Retroperitoneal abscess is a rare and difficult-to-diagnose condition. The delay in diagnosis is the primary cause of mortality. We did a case series investigation to describe the profiles of retroperitoneal abscesses. We obtained retrospective data from medical records. We reviewed thirty patients admitted to our hospital with retroperitoneal abscesses from January 2013 to December 2019. Of 30 patients reviewed, 56.67% were male, with 50.14 years-old mean age. Approximately 46.67% presented with a chief complaint of back pain, and about 63.33% of cases had a fever. The most prevalent source was genitourinary, which accounted for 60% of the cases. The most common type of abscess was the perirenal abscess. Diabetes mellitus, malignancy, and an immunocompromised condition were all prevalent comorbidities. Escherichia coli was the most prevalent pathogen (46.66%), followed by Klebsiella pneumoniae (26.67%). For genitourinary abscesses, percutaneous drainage was typically used, whereas surgical drainage was recommended for gastrointestinal abscesses. The mortality rate of those conditions was 13.33%. Retroperitoneal abscesses have a wide range of clinical manifestations and causes. The treatment for retroperitoneal abscesses differed depending on the etiology and severity of the infection.

Successful Treatment of Giant Perirenal Abscess Associated with Hepatitis B Complicated with Alcoholic Decompensated Cirrhosis: A Case Report

Successful Treatment of Giant Perirenal Abscess Associated with Hepatitis B Complicated with Alcoholic Decompensated Cirrhosis: A Case Report

Radiološki nalaz pneumomedijastinuma kao retke komplikacije emfizematoznog pijelonefritisa

Introduction: Emphysematous pyelonephritis is a rare, acute, and life-threatening necrotizing renal infection caused by gas-producing facultative anaerobes, such as Escherichia coli, Klebsiella, and Proteus, most commonly in the setting of underlying diabetes mellitus. Pneumomediastinum is a rare imaging finding in this disease, and a high index of suspicion is required for diagnosing emphysematous pyelonephritis in patients presenting with pneumomediastinum, in the right clinical setting. Case presentation: We present the case of a middle-aged female patient with symptoms and laboratory findings indicating infection, renal failure, and hyperglycemia, and a personal history of diabetes mellitus. The imaging procedures revealed findings of a severe and advanced necrotizing renal infection with parenchymal destruction and intraparenchymal gas collections extending into the perirenal and pararenal spaces. We established the diagnosis of emphysematous pyelonephritis accompanied by perirenal abscess formation and pneumoretroperitoneum, with gas collections propagating into the mediastinum. In the setting of such a severe form of infection, the patient underwent immediate surgery with left nephrectomy. Despite prompt and intensive treatment, the patient unfortunately succumbed to the disease during the postoperative period. Conclusion: Pneumomediastinum is a rare complication of retroperitoneal processes, and, when present, indicates their extensiveness, often being an ominous prognostic sign. By presenting this case, we aim to highlight the severity of this form of renal infection and the unequivocal need for immediate response, as well as to emphasize the significance of imaging findings, which are somewhat unusual, but should raise suspicion of an insidious and serious retroperitoneal infection.

Urinothorax, another complication of bladder tumor: case report

BackgroundRupture of the fornix is a rare and serious urological complication of obstructive pathologies. The main cause is ureteral stone, but rarely a bladder tumor. Described complications of fornix rupture are superinfection, perirenal abscesses and even sepsis, but not urinothorax.Case presentationPatient of 56 years old, active and chronic smoker, was hospitalized for anemia and obstructive renal failure on a non-documented bladder tumor; clinically, he was presented with hematuria and an intense right loin pain associated with homolateral basithoracic pain and dyspnea. The CT scan without injection showed a right perirenal collection with bilateral renal dilatation on endo-vesical tumor and a right pleural effusion of less abundance. The ratio of pleural fluid creatinine to blood creatinine was greater than 1, confirming urinothorax. As an emergency, a percutaneous nephrostomy was performed. After clinical stabilization, the patient underwent a trans-urethral resection of the bladder and derivation by a double j stent. The ultimate evolution was favorable.ConclusionsBeyond the metabolic complications secondary to obstructions, mechanical complications, which can also be fatal, must be included.

Antegrade double-J stent placement for the treatment of malignant obstructive uropathy: A retrospective cohort study

BackgroundUreteral double- J stent is usually inserted by retrograde approach to treating obstructed upper urinary tract. The antegrade approach, can be suitable alternative in certain situations without general or spinal anesthesia. The present study demonstrates the indications, success rate, and complications of this approach in treatmenting malignant obstructive uropathy. MethodsData of consecutive patients with malignant obstructive uropathy who underwent antegrade ureteral stenting in the Department of Interventional Radiology at Sahloul hospital from January 2013 to February 2020 was retrieved and retrospectively analyzed. ResultA total of 188 attempts of antegrade ureteral stent insertion was performed during the study period (left side = 78, right side = 82, bilateral = 14). The mean age was 54 years (range: 9–91 years). The indication of the antegrade stenting was the failure of retrograde approach in 63 patients.The single-stage approach was performed 103 times. A percutaneous nephrostomy was placed for the average duration of 22.4 days (range: 2–60 days) for subsequent attempts. Only four patients required general anesthesia. Ureteral obstruction was caused by bladder cancer (n = 92), uterine cancer (n = 31), prostate cancer (n = 28), colorectal cancer (n = 15) and retroperitoneal tumor (n = 8). A protective nephrostomy was left in situ in 44 cases for 48 h. Clinical success was achieved in 96% of the cases. Two and three patients required hospitalization for perirenal abscess and hematuria, respectively. ConclusionThis retrospective study shows that antegrade ureteral stent insertion has a high success rate with minimal complications. Trial registrationClinicalTrials.gov Identifier: NCT04649970. Registered december 2, 2020- Retrospectively registered,https://clinicaltrials.gov/ct2/show/NCT04649970;

Intermittent quick-check CT fluoroscopy-guided percutaneous drainage placement in patients with infected renal and perirenal fluid collections: 11-year experience.

We aimed to evaluate technical and clinical success and safety of computed tomography fluoroscopy (CTF)-guided percutaneous pigtail drainage (PPD) placement in patients with infected renal and perirenal fluid collections. This retrospective analysis comprised 44 patients (52.27% men; age, 57.1±18.5 years) undergoing low-milliampere (10-20 mA) CTF-guided PPD placement in 61 sessions under local anesthesia from August 2005 to November 2016. Infected fluid collections (n=71) included infected renal cysts (12.68%), renal and perirenal abscesses due to comorbidities (23.94%), or fluid collections after renal surgery or urological intervention (63.38%). Technical success was defined as PPD placement with consecutive fluid aspiration, clinical success as normalization or marked improvement of clinical symptoms (e.g., flank pain, fever) and inflammatory parameters (leukocyte count, C-reactive protein) after minimally invasive combination therapy (intravenous broad-spectrum antibiotics and drainage). Complications were classified according to the CIRSE classification. Overall, 73 single lumen PPD (7.5-12 F) were utilized (1 PPD per session, 69.86%; 2 PPD per session, 15.07%). In 4 cases, PPD could not be inserted into the fluid collection (4.11%) or could not be aspirated (1.37%), yielding overall 94.5% primary technical success. Mean duration of functioning PPD before removal was 10.9 days. Adverse events within 30 days comprised PPD failure (2.27%) or secondary dislocation (Grade 3, 11.36%) and one death (Grade 6, unrelated to intervention, 2.27%). Additional invasive measures after primary CTF-guided PPD were required in 5 patients (nephrectomy 6.82%, partial nephrectomy 2.27%, surgical drainage 2.27%). Thus, clinical success using only minimally invasive measures was achieved in 39 of 44 patients (88.64%). Given a minor proportion of patients requiring surgical revision, combined antibiotics and CTF-guided PPD of infected renal and perirenal fluid collections provides an excellent technical and clinical outcome.

COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis.

PurposeObstructive pyelonephritis is a common urologic emergency that requires prompt decompression of the collecting system. The COVID-19 pandemic has changed patient flow and healthcare strategies at numerous emergency departments across Brazil with still unknown consequences for the population. This study sought to investigate the impact of the COVID-19 outbreak on clinical outcomes in patients with acute obstructive pyelonephritis at a tertiary academic center.Materials and methodsAfter Institutional Review Board approval, a retrospective chart review of patients who required decompression of the collecting system due to acute obstructive pyelonephritis from June 2019 to July 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. Patients were assigned in “Pre-Covid” and “Post-Covid” groups based on the admission dates.ResultsA total of 63 patients were included, with 40 patients in the Pre-Covid group and 23 in the Post-Covid group. Patients from the Post-Covid group presented at the ER later after symptoms onset (7.8 vs. 4.3 days; p = 0.012), had higher rates of SIRS (57% vs. 25%; p = 0.012), perirenal abscesses (13% vs. 0%; p = 0.019), overall complications (p = 0.047) and presented longer hospital length of stay (7.6 vs. 3.8; p = 0.007).ConclusionDuring the COVID-19 pandemic, patients with acute obstructive pyelonephritis presented later for evaluation at the ER, had higher disease severity and longer hospital length of stay when compared to the pre-COVID group of patients with the same pathology.

Managing renal forniceal rupture secondary to ureteric calculi in line with the NICE 2019 Renal and Ureteric Stone Guidelines

Objective: To synthesise all available data to determine the best management for urolithiasis-related renal forniceal rupture (RFR), with particular reference to the National Institute for Health and Care Excellence (NICE) 2019 Renal and Ureteric Stone Guidelines. Methods: PubMed search to March 2020 using permutations of renal, forniceal, fornix, calyceal, calyx and rupture. Non-English abstracts, editorial comments, letters to the editor and abstracts of conference proceedings were excluded. Results: An initial PubMed search retrieved 126 titles which were screened for relevance and five further titles were added from associated references. 64 abstracts were subsequently assessed, with 25 articles proceeding to full paper review. Conclusions: In cases of RFR secondary to ureteric calculi, management options, including conservative management, for the stone should be considered without the decision being influenced by the presence of the rupture. Perirenal abscesses secondary to RFR are rare, occurring in less than 0.25% of cases. Evidence supports restricting antibiotic prophylaxis to patients with a history of recurrent urinary tract infections or a positive urine culture, in line with the European Association of Urology’s antibiotic stewardship general management principle. RFR is not inherently a contraindication to primary ureteroscopy, which has particularly relevance with the drive to meet the 2019 NICE recommendations. Level of evidence: Not applicable to this literature review.

Adrenal Incidentaloma In Patient with Bilateral Nephrolithiasis and Infectef Right Kidney Cyst

Adrenal incidentaloma (AI) is a rare case, with a prevalence of 3-7% in the general population. We report a case of a 66 year old female, presented with the history of bilateral flank pain. The patient was performed urologic evaluation due to suspicion of right perirenal abscess and left kidney tumor, and from abdominal CT scan it was found suprarenal mass. There were no signs and symptoms of hormonal hyperfunction. Radiological evaluation in the patient showed the present of malignant lesion. Therefore, adrenalectomy was planned. Before undergoing adrenalectomy, the patient had passed away 6 days after first surgery (right pyelolitotomy and unroofing cyst), with septic shock suspected as cause of death due to hospital-acquired pneumonia.

Our Experience in the Treatment of Grade 4 Renal Injuries

Introduction: The aim of this study is to evaluate treatment modalities in patients with Grade 4 renal injury. Materials and Methods: In this retrospective study, we included a total of 64 patients who were diagnosed with Grade 4 renal injury at our trauma center hospital from 2015 to 2019. Patients who underwent immediate laparotomy due to concomitant injuries or penetrating wounds were excluded from the study. Hemodynamic instability was the absolute indication for nephrectomy as well as failure to respond to conservative treatment. Results: In our study, 10 patients (15.6%) underwent immediate nephrectomy due to hemodynamic instability. In 15 out of 54 remaining patients, arterial embolization was performed. Twelve patients presented with urinoma which required intervention. In this subgroup of patients, a double J stent was inserted in four of the patients and a nephrostomy tube was placed in the remaining eight patients for perinephric space drainage. Nephrectomy was performed in four of the patients in the urinoma group. From the patients treated totally conservative, two presented with perirenal abscess, but only one underwent computed tomography-guided abscess drainage. Conclusion: Patients with Grade 4 renal injuries may be treated conservatively or in a minimally invasive way, and immediate nephrectomy should be performed only in case of hemodynamic instability.

Effect of minimally invasive surgery on upper urinary calculi with renal empyema and its effect on renal function

Objective To investigate the clinical effect of minimally invasive surgery in patients with upper urinary calculi and renal empyema and its effect on renal function. Methods Eighty-four patients with upper urinary calculi and renal empyema admitted from April 2016 to March 1818 were enrolled. The random number table was divided into control group and observation group, 42 cases in each group. The control group was treated with ureteroscopic lithotripsy. The observation group was treated with microchannel percutaneous nephrolithotomy. The effect of the patients was evaluated 3 days after surgery. The 7600 automatic biochemical analyzer was used to measure the levels of urea nitrogen, serum creatinine (Scr) and 24 h urine protein (24 h UP) before and after treatment. The enzyme-linked immunosorbent assay was used to measure the two groups before and after surgery. Hypersensitive C-reactive protein, tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6) levels, and endothelin (ET-1) levels, serum of patient was completed by enzyme-linked immunosorbent assay (ELISA) Cortisol (CORT), catecholamine (CA), plasma glutamate (GLU) levels, statistics and re-corded the incidence of stone clearance, septic shock, perirenal abscess, major bleeding and sepsis in the two groups. Effects and effects on renal function in patients. Results The levels of BUN, Scr and 24 h UP in the observation group were lower than those in the control group 3 days after surgery (P 0.05). The incidence of septic shock, perirenal abscess, massive hemorrhage and sepsis after operation was lower in the observation group than in the control group (P<0.05). Conclusions Microchannel percutaneous nephrolithotomy for upper urinary calculi with renal empyema can improve the renal function of patients, reduce inflammatory factors and stress response, and the incidence of postoperative complications is low. It is worthy of popularization and application. Key words: Urinary Calculi; Pyonephrosis; Minimally Invasive Surgical Procedures

Risk factors for complications of percutaneous ultrasound-guided renal biopsy in children.

Percutaneous ultrasound-guided renal biopsy (PURB) is an invasive but essential procedure in establishing the histologic diagnosis of pediatric renal diseases. Large studies which describe PURB complications and its contributory risk factors are scarce in the pediatric literature. Patients who underwent real-time PURB from September 2011 to August 2017 were retrospectively reviewed. Data pertaining to clinical characteristics, histologic diagnosis and biopsy-related complications were collected. In addition, the risk factors for complications were also analyzed. Overall, 183 patients (109 females) were enrolled and 201 biopsies were obtained. The mean age was 14.4 ± 13.7years. Over 98% of the biopsies were considered adequate in quality. The major complications were perirenal hematoma requiring blood transfusion (4 cases, 2.0%), followed by perirenal abscess (1 case, 0.5%) and arteriovenous fistula (1 case, 0.5%). All patients recovered without sequelae after treatment. Hypertension, low estimated glomerular filtration rate (eGFR) and anemia were more common in patients with complication than in those without. Further logistic regression model analysis demonstrated that eGFR <30ml/1.73m2/min was an independent risk factor for major complications. Perirenal hematoma needing blood transfusion is the most common major complication for children undergoing renal biopsy. Low eGFR is an independent risk factor for major complications. Early recognition and timely treatment should be delivered to children with renal function impairment accordingly.