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

Abstract

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.

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

“…Consistent with previous studies, lithiasis (48.0%) and diabetes mellitus (33.7%) remained the pre dominant risk factors in the present study [3,8,9,12,16,22] . Diabetes mellitus accounts for 33.3%62.5% of all PNAs [2,7,23] 43.5%47% of RAs [7,16,17] and 28%50%…”

“…The imaging results are shown in Table 6. women was noted, while in previous studies, the male: Female ratio was reported as 1:31:7 [7,18,20] , and a female predominance as high as 91.8% was also observed [16] . Diagnosis of RA or PNA remains challenging because the symptoms can be insidious and obscure [1,2] .…”

“…However there is a continuing argument about the proper treatment of middlesized abscesses [3,5,7,16] . Although the option of conservative management of RAs and PNAs seems attractive and feasible and successful cases have been reported [4,16] , those cases were selected and limitations in size, location and num ber of abscesses were obvious and in Iwamoto's case, the patient had received percutaneous drainage prior to conservative treatment [4] . In the present study, interventional approaches helped to detect the cause of disease and confirm the diagnosis, and culture of pus/aspirate/debris helped guide selection of an antibiotic regimen.…”

“…and K. pneumoniae have been the most common pathogens in recent years [3,10,16,18] . In this study, E. coli was most frequently isolated from patients with RA than those with PNA.…”

An Unusual Cause of Renal and Perirenal Abscesses: Candida albicans

“…A delay in diagnosis may lead to morbidity and mortality. The microorganisms responsible for renal and perirenal abscesses are usually gram negative and positive bacteria, mostly E. coli, K. pneumoniae, S. aureus and B. fragilis (3)(4)(5). Fungal organisms including C. albicans are uncommon causes of renal and perirenal abscesses.…”