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Perinephric and intranephric abscesses: a review of the literature
Abstract:
Perinephric and intranephric (renal cortical and corticomedullary) abscesses, which may coexist, are associated with considerable mortality (21 percent to 56 percent) and are often difficult to diagnose. Most cases of renal cortical abscess are due to hematogenous seeding from distant foci of infection (often involving Staphylococcus aureus), while corticomedullary and perinephric abscesses are most often due to complications of urinary tract infections. Newer noninvasive studies such as ultrasonography, computerized tomography, gallium scanning and indium-labeled leukocyte scanning may facilitate determination of the diagnosis. While antibiotic therapy alone may suffice for the treatment of cortical abscesses, surgical drainage is an added requirement for the treatment of perinephric abscess.
Insights
Perinephric and renal abscesses are serious infections with high mortality. Diagnosis is challenging, but advanced imaging aids detection, with varied treatments based on abscess location.
Area of Science:
- Nephrology
- Infectious Diseases
- Radiology
Background:
- Perinephric and intranephric abscesses present significant diagnostic challenges and high mortality rates.
- Renal cortical abscesses often stem from hematogenous Staphylococcus aureus infections.
- Corticomedullary and perinephric abscesses typically arise from urinary tract infection complications.
Purpose of the Study:
- To review the diagnosis and management of perinephric and intranephric abscesses.
- To highlight the diagnostic utility of newer imaging modalities.
- To differentiate treatment strategies based on abscess location.
Main Methods:
- Review of existing literature on renal and perinephric abscesses.
- Discussion of diagnostic imaging techniques including ultrasonography, CT, gallium, and indium-labeled leukocyte scans.
- Analysis of treatment approaches, including antibiotic therapy and surgical drainage.
Main Results:
- Abscesses can be classified as perinephric, renal cortical, or corticomedullary, and may coexist.
- Mortality rates range from 21% to 56%.
- Noninvasive imaging significantly improves diagnostic accuracy.
Conclusions:
- Early and accurate diagnosis of renal and perinephric abscesses is crucial for improving patient outcomes.
- Treatment varies, with antibiotic therapy potentially sufficient for cortical abscesses, while perinephric abscesses often require surgical intervention.
- Advanced imaging plays a vital role in differentiating and managing these complex infections.