Perirenal abscess

Definition
A perirenal abscess is an infection surrounding one or both kidneys.

Causes, incidence, and risk factors

More than 75% of perirenal abscesses are caused by urinary tract infections that start in the bladder, spread to the kidney, and then to the area surrounding the kidney. Other causes of perirenal abscess include urological surgery and bloodstream infection.

The most significant risk factor for perirenal abscess is the presence of Kidney stones that block urinary flow and serve as a reservoir for infection, because bacteria tend to stick to the stones and antibiotics can’t kill the bacteria there.

Stones are found in 20-60% of patients with perirenal abscess. Other risk factors for perirenal abscess include having an abnormal urinary tract, having had surgery on the urinary tract, trauma, and Diabetes.

Symptoms

Symptoms of perirenal abscess include flank or Abdominal pain, which may extend to the groin or even down the leg. More than half of all patients have fever. Many also have sweats and chills.

Signs and tests

Signs of perirenal abscess include tenderness in the back or abdomen. A urinalysis will show white cells and may also have red cells. A urine culture, if taken before antibiotics are given, may show one or more types of bacteria. Even if the urine culture is negative, white cells in the urine and a fever may indicate the presence of a perirenal abscess.

A CT scan or ultrasound of the abdomen may show an inflamed kidney area, which would suggest a perirenal abscess.

Treatment

Treatment of a perirenal abscess includes drainage of the pus, either by a catheter placed through the skin or via surgery. Antibiotics should also be given, initially by vein (IV).

Expectations (prognosis)

In general, prompt diagnosis and treatment of perirenal abscess should lead to a good outcome. If present, Kidney stones must be treated to avoid further infections.

In rare cases, infection can spread into the area around the kidney and into the bloodstream, which can be deadly.

Complications

A possible complication is a continuing infection, if Kidney stones are present.

Calling your health care provider

Call your health care provider if you have a history of Kidney stones and develop a fever, chills, burning with urination, or Abdominal pain. Also call if you develop a urinary tract infection.

Prevention

If you have Kidney stones, ask your doctor about the best way to treat them to avoid a perirenal abscess. If you undergo urologic surgery, keep the surgical area as clean as possible.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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