Renal abscess

The majority of UTIs are caused by a single organism however, in patients with stones, indwelling urinary catheters, or chronic renal abscesses, multiple organisms may be isolated. 

The urinary pathogens in complicated or nosocomial infections may include E colt, which accounts for less than 50% of these infections, Proteus spp., Klebsiella pneumoniae, Enterobacter spp.. Pseudomonas aeruginosa, staphylococci, and enterococci. Candida spp. have become common causes of urinary infection in the critically ill and chronically catheterized patient. The majority of UTIs are caused by a single organism however, in patients vrith stones, indwelling urinary catheters, or chronic renal abscesses, multiple organisms may be isolated. 

Biological agents BCG (Bacilli Calmette-Guerin) Acute toxicity Bladder irritation nausea and vomiting fever sepsis Delayed toxicity Granulomatous pyelonephritis hepatitis urethral obstruction epididymitis renal abscess... 

The ahUity to eradicate bacteria from the urine is related directly to the sensitivity of the microorganism and the achievable concentrations of the antimicrobial agent in the urine. Unfortunately, most susceptibifity testing is directed at achievable concentrations in the blood. There is a poor correlation between achievable blood levels of antimicrobial agents and the eradication of bacteria from the urine. In the treatment of lower tract infections, plasma concentrations of antibacterial agents may not be important, but achieving appropriate plasma concentrations appears critical in patients with bacteremia and renal abscesses. 

Renal Abscess. Indications for percutaneous drainage of renal fluid collections are perinephric and large intra-renal abscesses, as well as small intrarenal abscesses not responding to antibiotic therapy. Another indication are infected urinomas, which are treated by a single percutaneous drainage, or in combination with additional nephrostomy when a communication between the uri-noma and the urinary collecting system persists. 

Nervous system Hemibalismus and altered mental status occurred in a 59-year-old patient with cirrhosis who took a prolonged course of ciprofloxacin for a renal abscess [37 ]. 

Acute Bacterial Nephritis 304 Renal Abscess 304 Cystic Pyelitis and Ureteritis 304 Pyonephrosis 304... 

Fig. 15.15a,b. Renal abscess (courtesy of J.F. Chateil, MD). a US transverse scan of the left kidney (prone) showing a hypoechoic abscess (A) formation with possible capsular extension. b Corresponding contrast-enhanced CT delineating the abscess formation and the perirenal extension... 

Brook I (1994) The role of anaerobic bacteria in perinephric and renal abscesses in children. Pediatrics 93 261-264 Chambers T (1997) An essay on the consequences of childhood UTI. Pediatr Nephrol 11 178-179 Chan Y, Chan K, Yeung C et al (1999) Potential utility of MRI in the evaluation of children at risk of renal scarring. Pediatr Radiol 29 856-862... 

Pseudo- tumors Renal abscess, xanthogranulomatous pyelonephritis, segmental multicystic dysplasia, renal lymphangioma, obstructive urinoma, renal sarcoidosis ... 

Pseudotumoral acute pyelonephritis (Fig. 24.23), renal abscess and a necrotic renal tumor may have similar features. Inflammatory clinical and biological signs may also be observed in WT. Abdominal wall infiltration, when visible, is more suggestive of infectious disease. Fine-needle aspiration may help in such circumstances. Xanthogranulomatous pyelonephritis is a specific form of chronic... 

Fig.27.1a-d. ACDS (a), renal CT (b), DMSA (c) scan, and VCU (d) in a girl with renal abscesses. Left-sided renal scarring is the outcome (split-function 23%), but VUR is on the right side into a normal kidney... 

Urinary infections with Cory neb acterium urea-lyticum are uncommon but can expose the transplant to complications, such as ureteral obstruction, renal abscess formation or progressive destruction of the graft (Dominguez-Gil et al. 1999). Risk factors for this infection include prolonged ureteral... 

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