title: Clinical assessment of children with renal abscesses presenting to the pediatric emergency department.
abstract: Renal abscesses are relatively uncommon in children but may result in prolonged hospital stays and life-threatening events. We undertook this study to analyze the clinical spectrum of renal abscesses in children admitted to the pediatric emergency department (ED) and to find helpful clinical characteristics that can potentially aid emergency physicians for detecting renal abscesses in children earlier.
  
  
  
  From 2004 to 2011, we retrospectively analyzed 17 patients, aged 18 years or younger, with a definite diagnosis of renal abscess admitted to the ED. The following clinical information was studied: demographics, clinical presentation, laboratory testing, microbiology, imaging studies, treatment modalities, complications, and long-term outcomes. We analyzed these variables among other potential predisposing factors.
  
  
  
  During the 8-year study period, 17 patients (7 males and 10 females; mean age, 6.1 ± 4.5 years) were diagnosed with renal abscesses on the basis of ultrasonography and computed tomography findings. The 2 most common presenting symptoms were fever and flank pain (100% and 70.6%, respectively). All of the patients presented with leukocytosis and elevated C-reactive protein (CRP) levels. Organisms cultured from urine or from the abscess were identified in 11 (64.7%) patients, and Escherichia coli was the most common organism cultured. All patients were treated with broad-spectrum intravenous antibiotics with the exception of 4 children who also required additional percutaneous drainage of the abscess.
  
  
  
  Renal abscesses are relatively rare in children. We suggest that primary care physicians should keep this disease in mind especially when children present with triad symptoms (fever, nausea/vomiting, and flank pain), pyuria, significant leukocytosis, and elevated CRP levels. However, aggressive percutaneous drainage may not need to be routinely performed in children with renal abscesses.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.|School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Chen
authors.affiliation: School of Medicine, China Medical University, Taichung, Taiwan.|Department of Developmental and Behavioral Pediatrics, Children's Hospital of China Medical University, Taichung, Taiwan.
authors.forename: Huang-Tsung
authors.initials: HT
authors.lastname: Kuo
authors.affiliation: Department of Developmental and Behavioral Pediatrics, Children's Hospital of China Medical University, Taichung, Taiwan.|Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yu-Jun
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.|Department of Hemato-Oncology, Children's Hospital, China Medical University Hospital, China Medical University, Taichung, Taiwan.
authors.forename: Kang-Hsi
authors.initials: KH
authors.lastname: Wu
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Wen-Chieh
authors.initials: WC
authors.lastname: Yang
authors.affiliation: Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan. arthur1226@gmail.com.|College of Medicine, Chang Gung University, Taoyuan, Taiwan. arthur1226@gmail.com.
authors.forename: Han-Ping
authors.initials: HP
authors.lastname: Wu
mesh_terms: D018784:Abdominal Abscess / Q000150:complications / Q000175:diagnosis*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis*; D007710:Klebsiella Infections / Q000150:complications / Q000175:diagnosis*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
keywords: Children; Emergency department; Renal abscesses