Year : 2009 | Volume
: 52 | Issue : 3 | Page : 440--441
Renal and perinephric abscess due to Staphylococcus aureus
VP Baradkar, M Mathur, S Kumar
Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai - 400 022, India
V P Baradkar
Department of Microbiology, L.T.M.M.C and L.T.M.G.H, Sion, Mumbai - 400 022
|How to cite this article:|
Baradkar V P, Mathur M, Kumar S. Renal and perinephric abscess due to Staphylococcus aureus.Indian J Pathol Microbiol 2009;52:440-441
|How to cite this URL:|
Baradkar V P, Mathur M, Kumar S. Renal and perinephric abscess due to Staphylococcus aureus. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Aug 10 ];52:440-441
Available from: http://www.ijpmonline.org/text.asp?2009/52/3/440/55022
The causative agents of renal abscesses include Staphylococcus aureus, members of the family Enterobacteriaceae and Pseudomonas aeruginosa. ,,, The predisposing factors for renal and perinephric abscesses include diabetes mellitus, renal calculi, urethral obstruction, vesicourethral reflux (VUR) and other less common causes being intravenous drug abuse, chronic debilitating disease and immuno-compromised status. ,,,, Here we report a case of ruptured renal abscess in a patient without any predisposing factor, which was managed successfully with percutaneous drainage and antibiotic therapy.
A 20-year-old male was admitted with a history of mild fever, with chills and rigors since 15 days and history of pain in right flank region since one week. There was no history of burning micturition, hematuria or dysuria, or any major illness in the past. On examination the patient was febrile, with pulse rate of 100/min, blood pressure of 120/80. No pallor, icterus or lymphadenopathy was observed. The findings of the cardiovascular, respiratory and nervous system were within normal limits. There was tenderness observed in the right hypochondrium, fullness in the right renal triangle and a vague lump in the right subcostal hypochondrium.
The investigations revealed hemoglobin of 14 g/dl, total leukocyte count of 14000/ mm 3 with 80% neutrophils and 20% lymphocytes. His fasting blood glucose was 87 mg/dl and postprandial levels were 120 mg/dl. Renal function tests showed that the serum creatinine and blood uric acid were within the normal range. The urine routine examination revealed occasional pus cells. No casts or crystals were observed. The urine culture showed no growth of organisms. The ultrasonography (USG) [Figure 1] and computerized tomographic (CT) scan [Figure 2] were performed which showed findings suggestive of renal abscess, involving the midpole with extension in the right perinephric space and hepatorenal pouch. Plain and contrast-enhanced CT scan revealed a 4.4 × 3.4 × 6 cm-sized hypodense heterogeneously enhancing well-defined lesion with few cystic density areas within seen in the mid part of the right kidney. The lesion was causing a mass effect on the mid and lower group of calyces, and there was break in the lateral renal capsule. Fluid collections of approximately 8 × 2.5 × 3.2 cm in size,with thin enhancing wall and septae, were noted in the hepatorenal pouch, right paranephric space, with an extension into the right paracolic gutter. There was a break observed in the right posterior pararenal fascia with communication seen between the right paracolic lesion and the perirenal collection. The left kidney, bilateral ureters, urinary bladder and both the adrenals were normal. These findings were suggestive of ruptured renal abscess with extension seen in the perinephric space, hepatorenal pouch. There were no calculi or any obstruction observed. Diagnostic aspiration was performed, which yielded growth of Staphylococcus aureus . The isolate was sensitive to amoxycillin + clavulanic acid, amikacin, cefotaxime, ciprofloxacin and resistant to penicillin. Blood cultures were performed which yielded no growth of organisms.
The patient was started on intravenous cefotaxime and USG-guided percutaneous drainage was performed. The patient responded well to the treatment with subsidence of fever and pain. The intravenous cefotaxime was discontinued after seven days, after which the patient was shifted to oral ciprofloxacin for seven days. A repeat CT scan was performed which showed complete healing of the abscess.
Abscesses of the kidney account for 0.2% of all intraabdominal abscesses, while perinephric abscesses account for 0.02% of all abdominal abscesses.  These cases occur with some associated predisposing factors ,,,, but no such predisposing factors were noted in the present case. Gram-negative bacterial abscesses commonly develop due to rupture of corticomedullary abscess while staphylococcal infection develops due to the rupture of renal cortical abscess.  Approximately 30% of cases are attributed to hematogenous dissemination from other sites of infection such as wound infection, furuncles or pulmonary infections while in the remaining 70% of cases no obvious source can be found as in the present case. 
Successful treatment of renal abscess requires the use of approximate antibiotics along with percutaneous drainage. Early diagnosis and treatment of renal and perinephric abscess is important to prevent complications of septicemia or even death as reported earlier.
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