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Symptoms, Diagnosis and Treatment of Perinephric Abscess

Definition

A perinephric abscess is an encapsulated collection of pus in the perinephric space between the renal capsule and the renal fascia.

Etiology

Ascending Infection:

Perinephric abscesses most commonly develop as a complication of an ascending urinary tract infection, often originating as a renal abscess.

Hematogenous Infection with Staphylococci:

Before the antibiotic era, hematogenously disseminated gram-positive staphylococci were the leading cause of renal abscesses. Current risk groups include people who inject drugs, patients receiving dialysis, patients in intensive care, and patients with valvular heart disease or endocarditis.

Signs and Symptoms of a Perinephric Abscess

In contrast to a renal abscess, symptoms of a perinephric abscess develop slowly and are nonspecific. The typical presentation is a usually subacute infection lasting several days to weeks, with fever, chills, flank or abdominal pain, and malaise.

Perinephric Abscess: Diagnostic Workup

Urine Culture:

Obtain a urine culture before starting antibiotic therapy. It identifies the causative pathogen in only 30% of cases.

Laboratory Tests:

Obtain a complete blood count, coagulation studies (PTT, PT), CRP, liver enzymes, and kidney function tests. If sepsis is suspected, obtain blood cultures and blood gas analysis and measure procalcitonin.

Ultrasonography:

A perirenal hypoechoic mass may be seen on renal ultrasound. Possible signs of perirenal air include echogenic echoes with posterior acoustic shadowing.

Computed Tomography:

CT is the diagnostic test of choice [fig. perinephric abscess]. The perinephric abscess appears as a hypodense area. Air inclusions are possible. After administration of contrast medium, enhancement of the abscess margin produces a ring-like appearance.

CT of a right-sided perinephric abscess: left, axial plane; right, sagittal reconstruction. The patient reported night sweats and malaise but had no flank pain or fever. With kind permission, Prof. Dr. K. Bohndorf, Augsburg.

Treatment of a Perinephric Abscess

Treatment is the same as for a renal abscess and consists of adequate parenteral antibiotic therapy and percutaneous abscess drainage. See the section on renal abscess treatment.

References

Angel u.a. 2003 ANGEL, C. ; SHU, T. ; GREEN, J. ; ORIHUELA, E. ; RODRIQUEZ, G. ; HENDRICK, E.: Renal and peri-renal abscesses in children: proposed physio-pathologic mechanisms and treatment algorithm.
In: Pediatr Surg Int
19 (2003), Nr. 1–2, S. 35–9

Shu u.a. 2004 SHU, T. ; GREEN, J. M. ; ORIHUELA, E.: Renal and perirenal abscesses in patients with otherwise anatomically normal urinary tracts.
In: J Urol
172 (2004), Nr. 1, S. 148–50

  Deutsche Version: Perinephritischer Abszess

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