Analysis of 17 children with renal abscess

This study's aims to analyze the clinical characteristics of children with renal abscess and improve its diagnosis and treatment.

The clinical data of children diagnosed with renal abscess in our hospital from 2007 to 2016 were retrospectively analyzed, including clinical manifestations, laboratory tests, imaging examinations, and treatment measures.

17 children with renal abscess were enrolled with median age was 15 (1.5-163) months old. There were 7 girls and 10 boys. Fever was the most common symptom (82.4%). 58.9% of children suffered from abnormal urogenital function before onset, mainly manifested as ureteral abnormalities (41.2%), renal dysplasia, or non-functioning kidneys (17.6%). Acute C-reactive protein and erythrocyte sedimentation rate (ESR) were increased in more than 85% patients, but the elevation of procalcitonin was not significant (10%). 41.2% of the children had anemia, and 64.7% exhibited markedly elevated leukocytosis. All cases were negative by blood culture. The pathogen was mainly Gram-negative bacteria (47.1%), including Escherichia coli. The detection rate of Enterococcus and Candida albicans was 23.5%. Mycobacterium tuberculosis was found in 1 case. B-ultrasound and magnetic resonance imaging were most commonly used. All cases received anti-infective treatment. 10 cases were ineffective and underwent surgical treatment. There was a significant difference in the treatment outcome between abscesses larger and smaller than 4 cm (P < 0.05).

For children with fever, abdominal pain, or flank pain, together with elevated white blood cell count, CRP, ESR, and IL-6, especially when anti-infective effect is poor, renal abscess should be considered. The initial anti-infective treatment of renal abscess can use a step-down scheme. The regimen needs to strengthen the anti-Gram positive bacteria and fungal treatment, and consider the possibility of renal tuberculosis infection. Conservative anti-infective treatment can be used in children with abscess size smaller than 4 cm, while surgery is recommended in abscesses larger than 4 cm not responsive to drug therapy.