perinephric abscess

Introduction

see retroperitoneal abscess

Etiology

• complication of pyelonphritis
  • Escherichia coli or other gram-negative urinary pathogens
  • Staphylococcus aureus (hematogenous spread)
• risk factors
  • diabetes mellitus
  • urolithiasis

Pathology

• direct localized spread from pyelonephritis or urinary obstruction
• bacteremia and hematogenous spread

Clinical manifestations

• onset is generally insidious over several weeks
  • weeks of urinary symptoms followed by nonspecific symptoms
    • fatigue, malaise, fever, chills
• may be signs & symptoms of generalized infection including urosepsis

Differential diagnosis

• emphysematous pyelonephritis
• renal abscess

Management

• appropriate antibiotics
  • antibiotics alone generally sufficient for renal abscesses < 3 cm
• radiologic percutaneous drainage when >= 5 cm

More general terms

• kidney disease; renal disease
• retroperitoneal abscess