Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jan 6, 2016; 5(1): 108-114
Published online Jan 6, 2016. doi: 10.5527/wjn.v5.i1.108
Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study
Xiao-Qin Liu, Cheng-Cheng Wang, Yan-Bin Liu, Kai Liu
Xiao-Qin Liu, Cheng-Cheng Wang, Yan-Bin Liu, Kai Liu, Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Liu XQ analyzed the data and wrote the paper; Wang CC collected the data; Liu YB and Liu K designed the research.
Institutional review board statement: This study was reviewed and approved by West China Hospital Sichuan University Clinical Trials and Biomedical Ethics Committee.
Informed consent statement: This analysis used anonymous clinical data that were obtained from patients who provided informed written consent before treatment.
Conflict-of-interest statement: The authors declare that there is not conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Kai Liu, Center of Infectious Diseases, West China Hospital of Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu 610041, Sichuan Province, China. liubusiness@163.com
Telephone: +86-28-85423597 Fax: +86-28-85423597
Received: June 29, 2015
Peer-review started: July 4, 2015
First decision: September 17, 2015
Revised: September 28, 2015
Accepted: November 23, 2015
Article in press: November 25, 2015
Published online: January 6, 2016
Processing time: 191 Days and 2.8 Hours
Abstract

AIM: To elucidate the clinical, radiological and laboratory profiles of renal abscess (RA) and perinephric abscess (PNA), along with related treatment and outcome.

METHODS: Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identified from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition (ICD-10) codes (RA: N15.101, PNA: N15.102) between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients’ characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance profiles, treatment approaches, and clinical outcomes were collected and analyzed.

RESULTS: The mean age of the patients was 46.49 years with a male to female ratio of 41:57. Lumbar pain (76.5%) and fever (53.1%) were the most common symptoms. Other symptoms and signs included chills (28.6%), anorexia and vomiting (25.5%), lethargy (10.2%), abdominal pain (11.2%), flank mass (12.2%), flank fistula (2.0%), gross hematuria (7.1%), frequency (14.3%), dysuria (9.2%), pyuria (5.1%) and weight loss (1.0%). Painful percussion of the costovertebral angle (87.8%) was the most common physical finding. The main predisposing factors were lithiasis (48.0%), diabetes mellitus (33.7%) followed by history of urological surgery (16.3%), urinary tract infections (14.3%), renal function impairment (13.3%), liver cirrhosis (2.0%), neurogenic bladder (1.0%), renal cyst (1.0%), hydronephrosis (1.0%), chronic hepatitis B (1.0%), post-discectomy (1.0%) and post-colectomy (1.0%). Ultrasound (US) and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice. Escherichia coli (51.4%), Staphylococcus aureus (10.0%) and Klebsiella pneumoniae (8.6%) were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders.

CONCLUSION: Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.

Keywords: Renal abscess; Causative pathogens; Perinephric abscess; Diagnosis; Antibiotic resistance; Interventional treatment; Conservative treatment

Core tip: Renal and perinephric abscesses are uncommon but potentially lethal infectious diseases and the case-fatality rates most frequently cited in previous studies are still high. However, the previous case-fatality rates need to be updated, since prompt diagnosis and appropriate therapeutic strategies have contributed to lower mortality. This article reports the characteristics of patients identified with renal or perinephric abscesses and shares the management experience and outcome in West China Hospital during the last decade.