Renal and perinephric abscesses: analysis of 65 consecutive cases.
OBJECTIVE
The objective was to describe the last 10 years' experience of the diagnosis and treatment of renal, perinephric, and mixed abscesses in an academic reference center.


METHODS
The medical records of 65 patients with renal, perinephric, and mixed abscesses treated at our hospital from January 1992 to December 2002 were reviewed. The data collected included predisposing factors, symptoms, physical examination, initial diagnosis, laboratory and radiologic evaluation, treatment, and clinical outcome.


RESULTS
Perinephric abscesses were found in 33 (50.8%) patients, renal abscesses were found in 16 (24.6%), and 16 (24.6%) had mixed abscesses. Urolithiasis (28%) and diabetes mellitus (28%) were the most common predisposing conditions. The duration of symptoms before hospital admission ranged from 2 to 180 days (mean 20 days). Urine culture was positive in 43% of patients and blood culture was positive in 40% of patients. Most of the perinephric abscesses received an interventional treatment: surgical drainage (24%), percutaneous drainage (42%) or nephrectomy (24%). Most patients were cured (73.3%) on discharge from hospital. Mixed (renal and perinephric) abscess treatment was similar: percutaneous drainage (37.5%), surgical drainage (18.75%) or nephrectomy (37.5%). Most patients were cured (60%) on discharge from hospital. Renal abscesses, however, were treated medically in 69% of patients and 73% were cured on discharge from hospital.


CONCLUSIONS
Perinephric and mixed abscesses are successfully managed by interventional treatment. Renal abscesses can be managed by medical treatment only, reserving interventional treatment for large collections or patients with clinical impairment. Early diagnosis is an important factor in the outcome of renal and perinephric abscesses.
Coelho
Rafael Ferreira
RF
Department of Urology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil. coelho85@hotmail.com
Schneider-Monteiro
Edison D
ED
Mesquita
José Luís Borges
JL
Mazzucchi
Eduardo
E
Marmo Lucon
Antonio
A
Srougi
Miguel
M
D000038:Abscess / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents