Perirenal Abscess Research Articles

Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures

To report our experience of combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures. Eighteen patients (23 kidneys) with non-obstructive uropathy due to urine leaks underwent combined CT- and fluoroscopy-guided nephrostomy. All procedures were indicated as second-line interventions after failed ultrasound-guided nephrostomy. Thirteen males and five females with an age of 62.3±8.7 (40-84) years were treated. Urine leaks developed in majority after open surgery, e.g. postoperative insufficiency of ureteroneocystostomy (5 kidneys). The main reasons for failed ultrasound-guided nephrostomy included anatomic obstacles in the puncture tract (7 kidneys), and inability to identify pelvic structures (7 kidneys). CT-guided guidewire placement into the collecting system was followed by fluoroscopy-guided nephrostomy tube positioning. Procedural success rate, major and minor complication rates, CT-views and needle passes, duration of the procedure and radiation dose were analyzed. Procedural success was 91%. Major and minor complication rates were 9% (one septic shock and one perirenal abscess) and 9% (one perirenal haematoma and one urinoma), respectively. 30-day mortality rate was 6%. Number of CT-views and needle passes were 9.3±6.1 and 3.6±2.6, respectively. Duration of the complete procedure was 87±32 min. Dose-length product and dose-area product were 1.8±1.4 Gy cm and 3.9±4.3 Gy cm2, respectively. Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures was feasible with high technical success and a tolerable complication rate.

Outcome Analysis of Fornix Ruptures in 162 Consecutive Patients

Fornix rupture is a potential urologic emergency. In most cases, ureteral stones represent the underlying cause. Management of a fornix rupture is not standardized. In a retrospective analysis, we investigated 162 patients who had received a diagnosis of fornix rupture between 1994 and 2005. In all patients, the diagnosis was based on radiographic investigations with application of contrast media. We evaluated the parameters' underlying cause, associated symptoms, diagnostic and therapeutic procedures, and outcome in patients with a fornix rupture. There were 121 men and 41 women with a median age of 53 years (range 20-79 years). In 93.2% of patients, one or more symptoms were present at diagnosis. In 59.9% of cases, a ureteral stone was diagnosed; in 12.3%, the underlying cause was different; and in the remaining 27.8% of patients, no reason for a fornix rupture was found. In all patients, primary endoscopic therapy (96.3%) or insertion of a nephrostomy tube (3.7%) was performed. All patients had a bladder catheter inserted, and antibiotic treatment was given in 92% of patients. A renal or perirenal abscess or other secondary complications necessitating open operative revision did not develop in any patient. The retrospective manner is a limitation of our study. Comparison of subgroups may therefore be biased. Ureteral stones are the most frequent causes of a fornix rupture. With a low pressure system and antibiotic treatment, the outcome is excellent, and secondary complications can be effectively prevented. Parameters for conservative treatment are to be defined to reduce overtreatment of certain patients with a fornix rupture.

Ursachen und Verlauf bei Fornixruptur

Fornix rupture is a urological emergency situation. In most cases ureteral stones represent the underlying cause. We present the largest series ever reported. Between 1994 bis 2005 a total of 162 patients were diagnosed with a fornix rupture. There were 121 men and 41 women with a median age of 53 years (range: 20-79 years). We investigated the following parameters: underlying cause of fornix rupture, symptoms, diagnostic and therapeutic procedures. In 60% of cases a ureteral stone was found as cause and in another 28% we found no reason for fornix rupture. 93% of patients had one or more symptoms at the time of diagnosis. In all patients primary endoscopic therapy (96%) or insertion of a nephrostomy tube was performed (4%). Also, antibiotic treatment was given in 92% of patients. No patient developed a perirenal abscess or other relevant complication requiring open operative revision. We confirm that ureteral stones are the most frequent causes of fornix rupture. With a low pressure system and antibiotic treatment, secondary complications can be effectively prevented.

Cervical Spinal Epidural Abscess and Perirenal Abscess Associated with Diabetes Mellitus

A 56-year-old woman was admitted due to fever, thirst, polydipsia, polyuria, posterior cervical pain and lumbago. Hyperglycemia and urine white blood cell elevation were detected. Computed tomography showed left perirenal abscess. Urine culture and blood culture revealed Escherichia coli. We diagnosed perirenal abscess followed by pyelonephritis due to untreated diabetes mellitus. We used 6g of ampicillin-sulbactum daily and from the 10th day 4g of sulfamethoxazole-trimethoprim for perirenal abscess, and 180mg of loxoprofen sodium daily for posterior cervical pain in addition to a diabetic diet and insulin therapy for diabetes mellitus. Although the patient's fever normalized and lumbago improved, posterior cervical pain level increased and bilateral 1, 2 and 3 finger-numbness occurred from the 18th day. Cervical magnetic resonance imaging showed cervical 4, 5 and 6 vertebra inflammation induced spine compression. Removal of the cervical abscess and fixation of the vertebra were performed at the 27th day. Treating diabetes mellitus is important for the prevention of severe infection.

Renal Abscesses Measuring 5 cm or Less: Outcome of Medical Treatment without Therapeutic Drainage

PurposeDiagnosis and proper treatment of renal abscesses remains a challenge for physicians. We investigated the characteristics and comorbidity factors of renal abscesses measuring 5 cm or less and critically examined the effectiveness of conservative treatment.Materials and MethodsBetween February 2001 and March 2009 the records of 63 patients initially diagnosed at our hospital with renal or perirenal abscesses were retrospectively reviewed. In 63 patients with renal and perirenal abscesses, 51 abscesses measured 5 cm or less, and 49 abscesses were treated with intravenous antibiotics alone.ResultsMost patients were women (91.8%), and their mean age was 42.3 years. The mean size of renal abscesses was 3.6 cm. The most common predisposing condition was diabetes mellitus (DM) (46.9%). Common clinical features were fever (83.7%) and flank pain (53.1%). On urinalysis, 31 (64.6%) cases had positive bacterial cultures with Escherichia coli (50.0%) being the most common pathogen. All 49 patients were treated with broad-spectrum intravenous antibiotics alone. All patients showed complete clinical regression and resolution of the renal lesions shown by CT between 3 and 14 weeks. The average hospital stay was 15.3 days (range, 5-31 days). Significant predictors of a long hospital stay were age, abscess size, and DM.ConclusionMedium-sized as well as small-sized renal abscesses were treated successfully with intravenous antibiotics alone. DM was a significant predictor of prolonged hospital stay. If therapeutic drainage is believed to involve considerable risk, then intravenous antimicrobial therapy may be a good alternative treatment.

Candida Glabrata Fungemia After Amputation of an Infected Diabetic Foot

A 58-year-old woman suffered from left pyelonephritis with diabetic triopathy on admission at which time a double J stent was inserted in the left ureter and was left untreated for a year. She was admitted due to fever, thirst, polydipsia, polyuria and, left 1,2-toe ulcer and vacuole. We diagnosed diabetic foot infections. We used 6g of ampicillin-sulbactum and 40μg of alprostadil alfadex daily in addition to diet and insulin therapy for diabetes mellitus. As the toe lesion deteriorated, a left foot amputation was performed at the 11th day. The subfever continued and the consciousness level deteriorated from alert to 100 on the Japan coma scale and acute respiratory failure occurred 21 days after operation. Whole body computed tomography showed invasive lesions in bilateral pulmonary lower lobes and renal pelvic dilatation and perirenal abscess in left kidney indicating renal abscess. Milk-like urine was excreted. Urine and blood culture detected Candida glabrata. Fundoscopic exam showed retinal exudates indicating mycotic endophthalmitis. We diagnosed candida glabrata sepsis from pyelonephritis. After using 200mg of micafungin daily, the patient recovered. In addition to exchanging the stent, treatment of diabetes mellitus is important for the prevention of severe infection.

Hepatic portal venous gas induced by emphysematous pyelonephritis: a rare case in hemodialytic women

Hepatic portal venous gas (HPVG) became more easily diagnosed after the advent of abdominal computed tomography scan in the emergency department. However, the clinical significance of HPVG is popularly discussed; and its etiology remains uncertain. In this report, we present a 49- year-old diabetic, hemodialytic woman who presented with afebrile flank pain and a significant HPVG detected on abdominal computed tomography, which implied a unilateral perirenal abscess (so-called emphysematous pyelonephritis). This patient received percutaneous drainage and antibiotics therapy without emergency laparotomy intervention. No evidence of existing mesenteric infarction or bowel obstruction was detected during admission, and the patient was discharged with an uneventful outcome. To our knowledge, this is the first case of HPVG that originated from emphysematous pyelonephritis and was treated by successful emergency drainage.

Crioterapia renal laparoscópica: experiencia inicial

Objective Renal cryotherapy has been described as a minimally invasive procedure that represents an alternative for selected patients with small renal tumors. Our preliminary experience with this procedure is reported. Material y methods Eighteen patients with 21 tumors with a mean tumor size of 2.2 cm (1-4) in the preoperative CT scan underwent renal cryotherapy using a double freeze-thaw cycle. The group consisted of 14 males (64%) and 4 females (18% with a mean age of 68 years (32-84). All patients had undergone prior surgery for renal tumor in the treated or the opposite kidney. A transperitoneal laparoscopic approach was used in all patients. Results Mean operating time was 196 minutes (120-140), and no patient received transfusions during or after surgery. No complications occurred in 14 patients (64%). Perirenal abscess, splenic laceration, ureteral lesion, and polar artery lesion occurred in one patient each. Peroperative biopsy was performed in 5 patients (22.7%) and was positive for renal cancer in two cases, while material was insufficient in three patients. Mean hospital stay was 6 days (2-16). Creatinine levels were 106 mg% (48-230) before surgery and 123 mg/% (52-270) 6 months after surgery. A CT scan was performed in all patients one and six months after surgery, showing a residual enhancement area in two of them. Sixteen patients (88.8%) are disease-free after a mean follow-up time of 46 months (6-116). Metastatic disease occurred in two patients (11%) in the setting of a prior renal tumor in the same or the opposite kidney and required treatmet with antiangiogenic agents. Conclusions This is the largest series reporting renal cryosurgery in Spain, in complex cases and with adequate follow-up. Results are encouraging and allow for considering renal cryotherapy among the minimally invasive procedures for nephron-sparing surgery.

Emphysematous Pyelonephritis Presenting as Necrotizing Fasciitis of the Leg

We report a 50-year-old man with poorly controlled diabetes mellitus who presented with a painful, swollen right leg. He had also experienced right flank pain for 1 week prior to admission. Physical examination was notable for tenderness over the right flank. The right leg was diffusely swollen and exquisitely tender to touch, with palpable crepitance. Laboratory tests revealed leukocytosis and pyuria. Computed tomography showed a right ureteral stone with hydronephrosis and characteristic findings of emphysematous pyelonephritis. Furthermore, a right perirenal gas-forming abscess with extension to the right leg was noted. The patient was successfully treated with antibiotic therapy, aggressive control of blood sugar, percutaneous drainage of the hydronephrosis and perirenal abscess, and aggressive debridement of the leg.

Aktinomykose der Niere: Ein Fallbericht

Actinomycosis is a rare infection mainly of the head and neck region (cervicofacial actinomycosis). The cause of this infection is bacterial invasion of the host's mucosal barrier with consecutive infiltration of the surrounding tissues. The treatment of choice after diagnosis is a prolonged course of high-dose antibiotics. The presence of abdominal actinomycosis is at a maximum of 25%, whereas renal involvement appears only sporadically. Aggravating causes for early diagnosis are the appearance of abscesses, fistulae and a debilitating illness resembling carcinoma and leading to surgery as the treatment of choice. Renal actinomycosis is a diagnostic challenge because it is included in the differential diagnosis of renal masses with coexisting B-symptoms. The suspicion requires surgical treatment--nephrectomy. We report on a patient who was transferred to our department for nephrectomy because of radiologically diagnosed renal and perirenal abscesses. The histological result showed renal actinomycosis.

Ultrasonographic and Computed Tomography Findings in Renal Suppurations: Performance Indicators and Risks for Diagnostic Failure

Objectives: The main purpose of the study was to identify and quantify clinical variables which predisposed incorrect diagnosis based on ultrasonography (US) and computed tomography (CT) findings in the patients with suppurative renal infections. Patients and Methods: A retrospective review of radiological records of patients at 3 tertiary Serbian clinics of urology from 1999 to January 2006 was conducted. The series consisted of 49 women and 26 men, mean age = 56.7 years, ranging from 21 to 78. All patients underwent US examinations. Forty-one patients had undergone CT examinations, on 42 renal units (1 bilateral perirenal infection). The patients were categorized into 4 groups according to the type of suppurative infection: (a) unilocular renal or perirenal abscesses; (b) with pyonephrosis only; (c) with multiple renal or pyonephrosis infections along with extension on perirenal space, and (d) emphysematous infections. Results: Incorrect diagnosis based on US record only depended on the suppurative entity. In the presence of pyonephrosis only, the risk of incorrect diagnosis was reduced for 4 times [odds ratio (OR) = 0.25], and in presence of emphysematous infections the risk increased 19.5 times (OR = 19.49). Perinephric abscesses which were not seen on US were those associated with pyonephrosis, abscesses smaller than 6 cm and gas-forming abscesses. The diagnosis of abscesses considerably varied in the cases of unilocular purulent collections compared to complex purulent collections (χ² = 8.177, p = 0.004). Overall, the risk for incorrect diagnosis is about 14 times higher using US only (OR = 14.5), while CT reduced the risk of it for about 37 times (OR = 0.027). Conclusions: CT was much more reliable than US to correctly identify the pathological entity of renal suppuration. Guiding treatment on US findings only seems hazardous as omission of some pathological processes is very likely.

Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases

Background/AimsThe aim of this study was to examine the recent clinical trends and antibiotic susceptibilities of the causative microorganisms in renal and perirenal abscesses, and to elucidate the factors associated with treatment strategies.MethodsWe retrospectively analyzed 56 patients who were diagnosed with renal and perirenal abscesses at our hospital from January 2000 to September 2007.ResultsThe mean age of the patients was 53.5 years, and a female predominance of patients (75%) was observed. Diabetes mellitus (44.6%) was the most common predisposing condition. The mean duration of symptoms before diagnosis was 11.6 days, and fever (75%) was the most common symptom. Escherichia coli (44%) and Klebsiella pneumoniae (28%) were common pathogens, and the rates of susceptibility of E. coli isolates to ampicillin, cephalothin, cefotaxime, trimethoprim-sulfamethoxazole, ciprofloxacin, gentamicin, and imipenem were 18.2%, 27.3%, 72.7%, 72.7%, 63.6%, 63.6%, and 100%, respectively. Abscesses were classified according to the location as follows: renal abscess (n=31, 55.4%) and perirenal abscess±renal abscess (n=25, 44.6%). In the renal abscess group, the infection rate of gram-negative organisms was higher than in the perirenal abscess group. Patients were also divided according to the treatment modality: antibiotics only (n=20, 35.7%) and percutaneous intervention or surgery (n=36, 64.3%). Patients who had a perirenal abscess or a large renal abscess required more invasive treatment.ConclusionThis study revealed somewhat different results from those of previous studies. Clinical and microbial differences were observed between the renal and perirenal abscess groups. Abscess location and the size of the renal abscess were the factors associated with treatment strategies.

Efficacy and Safety of a New-Generation Shockwave Lithotripsy Machine in the Treatment of Single Renal or Ureteral Stones: Experience with 2670 Patients

To review the treatment efficacy and to assess the complications encountered in patients with single renal or ureteral calculi managed with a new-generation SWL machine, the Siemens Lithostar Modularis Uro-Plus. The stone location, size, minimum and maximum energy used, localization technique, number of shockwaves, fluoroscopy time, and number of sessions were reviewed for 2670 patients. The medical records were consulted to identify post-SWL secondary treatments in order to calculate the efficacy quotient (EQ). The stone-free rate was 79%. Calculi in the renal pelvis and upper, middle, and lower ureter had success rates of 86%, 86%, 86%, and 85%, respectively (P < 0.05). Higher re-treatment rates were encountered for midureteral stones (P < 0.05). The major complications were renal hematoma, acute pyelonephritis, perirenal abscess, and acute pancreatitis. The overall EQ was 0.67. The EQ was higher for the renal pelvis (0.73) and upper ureter (0.71). Our experience has shown that this new lithotripter is safe and provides a 68% to 86% chance of stone clearance.

Mortality and Complications Associated with Percutaneous Nephrostomy in Patients with Ureteral Obstruction Related to Advanced Cervical Cancer

Introduction: Percutaneous nephrostomy is a well-established technique leading to the rapid resolution of ureteral obstruction and recovery of renal function in patients suffering from obstructive uropathy. However, its role in managing renal failure secondary to obstruction due to advanced abdominal neoplasia remains controversial. Objective: Describing the demographic variables, the complications associated with intervention, the course of obstructive uropathy and several outcomes. Materials and methods: 106 cases suffering from advanced cancer of the cervix and ureteral obstruction treated with percutaneous nephrostomy were included in the study. The patients were divided into 2 groups; 37 women with locally advanced, recently diagnosed cancer of the cervix which had not been treated so far were included in group A and 69 patients having recurrent tumours were included in group B. Results: 106 women, aged 24 to 75 (46,2 mean, SD±13,1), were included in this study; 9 (8,5%) had cancer of the cervix stage IIB, 68 (64%) had tumours stage IIIB and 29 (27,5%) were suffering from IVA stage. 102 women received pelvic radiotherapy plus brachytherapy and 4 were treated with chemotherapy plus radiotherapy concomitantly. 90 patients were diagnosed as suffering bilateral urinary obstruction; this was unilateral in 16 of them. 90% of the patients had abnormal renal function tests when undergoing the procedure. 13,2% of the patients presented bleeding following the procedure, 26% had hydro-electrolytic alterations, 12% of the patients had intraor peri-renal abscesses and 6% had an infection at the insertion site. The mean of how long nephrostomy was applied was 5,2 and 6,9 months for groups A and B respectively. 53% of the patients required 1 or more changes of catheter during this time and 147 episodes of infection of the urinary routes were documented (3,12 infections for each 100 days/catheter). Recurrent infection was more frequent in patients from group B (p=0,03), in those with an albumin level less than 2.5 mg/dl (p=0,011), in those who had been diagnosed as having rectal or vesicovaginal fistula (p = 0,02) and in those requiring more than 2 changes of catheter (p=0,05). 37% (n=39) of the patients died from sepsis having a urinary origin. Average stay in hospital (DPVU) was 71 days and mean survival 14,9 and 7,3 months in groups A and B, respectively. The average number of days of being hospitalised attributable to urinary infection following nephrostomy was 20,3 days. Conclusion: DPVU is not recommendable in patients suffering from recurrent disease (in spite of having a good base functional state) due to the large proportion of ascribable complications, especially of infectious origin.

Abdominal Nontuberculous Mycobacterial Infection in a University Hospital in Taiwan from 1997 to 2003

Abdominal nontuberculous mycobacterial infection is a rare condition. Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis is the most common manifestation of infection due to nontuberculous mycobacteria (NTM). There are limited data on the clinical manifestations of nontuberculous mycobacterial infection. This study investigated the diagnostic features, clinical presentation, mycobacteriology, treatment and outcome of all abdominal NTM infections treated over a 7-year period at a major teaching hospital in Taiwan. The medical records of all patients with a diagnosis of abdominal NTM infection from January 1997 through to December 2003 were retrospectively reviewed. All 11 patients with abdominal NTM infections identified during the 7-year period were included. Among these patients, six were male and five were female, with a mean age of 64.5 years. The disease manifested as peritonitis (9 patients, 82%), splenic abscess (1, 9%), or perirenal abscess (1, 9%). Most patients (73%) had underlying malignancy, most often hepatoma (45%). Immunocompromised status (liver cirrhosis, malignancy, acquired immunodeficiency syndrome) was noted in 10 patients (91%). None of our patients who developed NTM peritonitis had received CAPD. The peritoneal fluid appearance varied considerably, with no particular predominance of clear, turbid, bloody, or chylous findings. Rapidly growing mycobacteria were the major etiology (46%) of abdominal NTM infection, and Mycobacterium abscessus played a major role (27%). Overall, eight patients died, and only one patient survived longer than 1 year. Seven patients (64%) died before diagnosis. Abdominal NTM infection is frequently overlooked because of its rarity and nonspecific symptoms, with consequent delays in diagnosis and treatment. In immunocompromised patients with ascites from any cause (liver cirrhosis, malignant ascites, etc.), NTM peritonitis should be considered early in the differential diagnosis of symptoms including fever, abdominal pain and weight loss. The poor prognosis of abdominal NTM infection appears to be related to the severity of underlying conditions, most often malignancy.

Bilateral Perirenal Abscesses in a Domestic Neutered Shorthair Cat

Journal of Veterinary Internal MedicineVolume 18, Issue 6 p. 902-903 Open Access Bilateral Perirenal Abscesses in a Domestic Neutered Shorthair Cat Andrea Zatelli, Corresponding Author Andrea Zatelli private practice Clinica Veterinaria Pirani, Reggio Emilia, Italy. Clinica Veterinaria Pirani, Via Majakowski n. 2/L, M, N—42100 Reggio Emialia, Italy; e-mail: clinvet-pirani@libero.it.Search for more papers by this authorPaola D'Ippolito, Paola D'Ippolito private practice Clinica Veterinaria Pirani, Reggio Emilia, Italy.Search for more papers by this author Andrea Zatelli, Corresponding Author Andrea Zatelli private practice Clinica Veterinaria Pirani, Reggio Emilia, Italy. Clinica Veterinaria Pirani, Via Majakowski n. 2/L, M, N—42100 Reggio Emialia, Italy; e-mail: clinvet-pirani@libero.it.Search for more papers by this authorPaola D'Ippolito, Paola D'Ippolito private practice Clinica Veterinaria Pirani, Reggio Emilia, Italy.Search for more papers by this author First published: 05 February 2008 https://doi.org/10.1111/j.1939-1676.2004.tb02640.xCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume18, Issue6November 2004Pages 902-903 ReferencesRelatedInformation

Spontaneous nephrocutaneous fistula

Spontaneous renal fistula to the skin is rare. The majority of cases develop in patients with antecedents of previous renal surgery, renal trauma, renal tumors, and chronic urinary tract infection with abscess formation. We report the case of a 62-year old woman, who complained of urine leakage through the skin in the lumbar region for 2 years. She underwent a fistulography that revealed drainage of contrast agent to the collecting system and images suggesting renal lithiasis on this side. The patient underwent simple nephrectomy on this side and evolved without intercurrences in the post-operative period. Currently, the occurrence of spontaneous renal and perirenal abscesses is extremely rare, except in patients with diabetes, neoplasias and immunodepression in general.

RENAL AND PERIRENAL ABSCESSES IN PATIENTS WITH OTHERWISE ANATOMICALLY NORMAL URINARY TRACTS

We characterized evaluation, management and outcomes in a group of patients diagnosed with renal and perirenal abscesses who had otherwise anatomically normal urinary tracts. We reviewed our experience with renal/perirenal abscesses at University of Texas Medical Branch from 1991 to 2002. Treatment was determined by physician preference in each individual. Of 70 patients with renal/perirenal abscesses 26 had otherwise anatomically normal urinary tracts, 24 (92%) had at least 1 possible contributory factor, such as diabetes mellitus, and only 38% had the correct diagnosis at initial presentation. The abscess was intranephric in 39% of cases, intranephric and perinephric in 19%, and perinephric only in 42%. Of the 26 patients 18 were treated with percutaneous drainage or aspiration of the abscess and 12 (66.7%) had positive cultures. Eight of the 12 patients (67%) with positive abscess cultures had the same organism in urine and/or blood. All 26 patients were treated with broad-spectrum intravenous antibiotics. In most patients abscess size influenced additional treatments, such as percutaneous needle aspiration or catheter drainage. None of the patients required open surgical drainage, nephrectomy or nephrostomy tube placement. At a mean followup of 10 months all patients had complete radiographic resolution of the abscess without further complications except 1 who had pyelonephritis and another who was found to have a poorly perfused kidney. With accurate diagnosis and minimally invasive therapy patients with renal and/or perirenal abscesses and otherwise anatomically normal urinary tracts have excellent functional and anatomical outcomes.

Bilateral Perirenal Abscesses in a Domestic Neutered Shorthair Cat

Bilateral Perirenal Abscesses in a Domestic Neutered Shorthair Cat

Isolated Renal Mucormycosis in Children

Mucormycosis (invasive zygomycosis) usually affects patients with debilitating conditions such as cancer and diabetes mellitus. While renal involvement is not uncommon in disseminated mucormycosis, isolated renal mucormycosis is extremely rare, especially that which does not exhibit any predisposing factors, and few cases have been reported in the literature. We report on 3 children with isolated renal mucormycosis. CASE REPORTS Case 1. A 3-month-old preterm (36 weeks) female presented with a right lumbar mass 2 months in duration without fever or hematuria. The mother appeared healthy, and AIDS and fungal evaluations were negative during gestation. On physical examination a well demarcated hard mass about 6 cm in diameter was palpated in the right lumbar region, which was shown on B-ultrasound (B-US) to be a solid mass of the upper kidney. Right nephroblastoma was diagnosed preoperatively. During exploratory surgery a 6.0 6.0 5.0 cm mass was located in the upper part of the right kidney. The upper part of the mass adhered closely to the hepatic flexure of the colon. Many swollen lymph nodes were found in the mesentery of the ascending colon. Complete resection was difficult, so the majority of the mass was excised and swollen lymph nodes in the mesentery were biopsied. Case 2. A 12-year-old otherwise healthy student presented with a 1-month history of fever followed by 1 week of severe right lumbar pain and hematuria. No history of diabetes mellitus or AIDS was noted. Initial treatment with cephalosporin was ineffective and B-US detected a renal abscess. On admission to the hospital the patient had a body temperature of 40C, and there was marked tenderness and percussion pain in the right lumbar region and slight tenderness in the bladder region. Abdominal computerized tomography showed diffuse enlargement and multiple low density areas of the right kidney with several small perirenal abscesses. Renal perfusion scans demonstrated a nonfunctioning right kidney. Renal abscess was diagnosed and surgically managed. During surgery the right kidney became markedly swollen and soft, and many foci could be seen. There was about 100 ml yellow-white pus in the abscess, which was aspirated for fungal culture, and renal parenchyma was biopsied. Case 3. A 14-year-old boy was hospitalized with fever, hematuria and flank pain 1 month in duration, deteriorating with dysuria, polyuria and pyuria for 2 weeks. No predisposing diseases or recent drug abuse could be elicited. Gross hematuria was observed, routine urinalysis revealed numerous hyphae of Mucor corymbifer and red blood cells were (4). Body temperature was 39.5C. Marked tenderness and percussion pain were noted in the right lumbar region and bladder region. B-US detected a low echo right kidney. Excretory urography and renal perfusion showed a nonfunctioning right kidney. Therefore, renal mucormycosis with infarction was diagnosed. The patient was administered systemic amphotericin B and subsequently underwent right nephrectomy. Pathological results. Frozen sections in cases 1 and 2 demonstrated the mass was mainly inflammatory and necrotic tissue, and many fungi were scattered in the tissue. Hematoxylin and eosin sections confirmed the diagnosis of mucormycosis in all 3 cases, although fungal cultures were negative in case 2. The diagnostic criteria were established only when frozen and hematoxylin and eosin sections were consistent with acute purulent inflammation, and the broad nonseptate fungal hyphae with right angled branches, typical of M. corymbifer, were detected in the tissue (fig. 1). The hyphae were readily observed by silver staining and periodic acidSchiff reaction (fig. 2). The swollen lymph nodes in case 1 were confirmed to be reactive proliferation of inflammation without M. corymbifer. Antifungal treatment (intravenous amphotericin B lipid complex at a daily dose of 2 mg/kg and a total dosage of 300 to 2,160 mg during 3 to 4 weeks, followed by 30 to 50 mg/kg 5-fluorocytocine orally per day for 3 months) followed or was continued after nephrectomy. The 3 children recovered uneventfully, and hepatic and renal function remained normal during followup. DISCUSSION Mucormycosis occurs predominantly in immunocompromised patients, in whom it carries a serious prognosis. Mucormycosis can usually be divided into 5 different subtypes— cerebral, pulmonary, gastrointestinal, cutaneous and systemic, none of which is uncommon. Renal involvement is