Renal abscess
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At the time the article was created Jeremy Jones had no recorded disclosures.
View Jeremy Jones's current disclosuresAt the time the article was last revised Mohammad Taghi Niknejad had no financial relationships to ineligible companies to disclose.
View Mohammad Taghi Niknejad's current disclosures- Renal abscesses
- Abscess involving kidney
- Kidney abscess
- Intrarenal abscess
- Intranephric abscess
Renal abscess is a collection of infective fluid in the kidney. It is usually a sequela of acute pyelonephritis, where severe vasospasm and inflammation may occasionally result in liquefactive necrosis and abscess formation.
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Epidemiology
It can affect all ages and has no recognized gender predilection.
Risk factors
The predisposing factors include 4:
diabetes mellitus
ureteral obstruction
Clinical presentation
The most common signs or symptoms are:
fever
flank/abdominal pain
chills
dysuria
Radiographic features
Ultrasound
A renal abscess typically appears as a well-defined hypoechoic area within the cortex or the corticomedullary parenchyma. It demonstrates internal echoes within, and an associated diffusely hypoechoic kidney due to acute pyelonephritis may be seen. Perinephric collection may also be seen.
CT
CT is currently the most accurate modality for diagnosis and follow-up of renal abscesses 1. An abscess appears as a well-defined low attenuation mass with a thick, irregular wall or pseudo capsule, which can be better visualized on contrast enhanced scans. Gas within a low attenuation/cystic mass strongly suggests abscess formation. Renal parenchyma around the abscess cavity may appear hypoenhancing in nephrogram phase and may appear hyperattenuating in delayed images. Associated fascial and septal thickening is seen with obliteration of perinephric fat.
In some cases, the formation of a discrete abscess is preceded by acute focal lobar nephronia which is a focal inflammation of the kidney without liquefaction. It appears as a solid mass.
Treatment and prognosis
Treatment consists of intravenous antibiotics and drainage, which may be performed under either ultrasound or CT guidance.
Complications
The main complication is abscess rupture, which can be described according to the space involved:
calyceal system - pyonephrosis
anterior or posterior pararenal space beyond the perirenal fascia - paranephric abscess
peritoneal cavity - subdiaphragmatic or pelvic abscess
These complications may lead to renal atrophy secondary to compression or obstruction.
Differential diagnosis
General imaging differential considerations include:
Quiz questions
References
- 1. Kawashima A, Sandler C, Goldman S, Raval B, Fishman E. CT of Renal Inflammatory Disease. Radiographics. 1997;17(4):851-66. doi:10.1148/radiographics.17.4.9225387
- 2. Papanicolaou N & Pfister R. Acute Renal Infections. Radiol Clin North Am. 1996;34(5):965-95. PMID 8784392
- 3. Anil T. Ahuja. Diagnostic Imaging: Ultrasound (Diagnostic Imaging). (2007) ISBN: 1416049177
- 4. Yen D, Hu S, Tsai J et al. Renal Abscess: Early Diagnosis and Treatment. Am J Emerg Med. 1999;17(2):192-7. doi:10.1016/s0735-6757(99)90060-8
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