- 作者：Brian J. Linder Linder.Brian@mayo.edu" class="auth_mail" title="E-mail the corresponding author ; Candace F. Granberg ; Granberg.Candace@mayo.edu" class="auth_mail" title="E-mail the corresponding author
- 关键词：Pediatric ; Renal abscess ; Management
- 刊名：Journal of Pediatric Urology
- 出版年：2016
- 出版时间：April 2016
- 年：2016
- 卷：12
- 期：2
- 页码：99.e1-99.e5
- 全文大小：586 K
id="absSec_2">Objective
id="abspara0015">This study evaluated the presentation, management and outcomes of a contemporary cohort of pediatric patients with renal abscesses.
id="absSec_3">Study design
id="abspara0020">A total of 16 consecutive pediatric patients with radiologically diagnosed intra-renal or peri-nephric abscesses from 1990 to 2012 were identified. Patients were identified by querying institutional records via ICD-9 and CPT codes referencing renal abscess. Charts were retrospectively reviewed to evaluate multiple clinical variables, including: presenting symptoms, size of abscess, management strategy and clinical outcomes. Clinical resolution was confirmed via repeat ultrasound or computed tomography.
id="absSec_4">Results
id="abspara0025">The median age at presentation was 13 years (range 1 month–18 years) and 13/16 patients (81%) were female. Abscess formation was secondary to: urinary tract infection in 13 (81%); hematogenous seeding from a skin infection in one (6%); and an unknown etiology in two (12%) patients. The most common organism identified on urine culture was Escherichia coli (10, 77%). Hematogenous seeding was confirmed in only one case, with Staphylococcus aureus growing on culture from both a cutaneous lesion and percutaneous drainage of the renal lesion. Overall, abscesses were a median of 2.2 cm (IQR 2, 3.7), with 13 (81%) successfully managed with conservative therapy, including intravenous antibiotics, with resolution on repeat imaging at a median of 21 days (range 6–55). For patients presenting with abscesses ≤3 cm, conservative measures were employed in 10/11 cases, with 100% success rate. Three patients had larger abscesses (3.8, 4, and 10 cm), which resolved after treatment with percutaneous drainage. A voiding cystourethrogram was performed in 10 patients, with two (20%) detecting an abnormality (low-grade vesicoureteral reflux, which required no further intervention).
id="absSec_5">Conclusions
id="abspara0030">Pediatric renal abscesses were most commonly small and secondary to an E. coli UTI. Most small (≤3 cm) renal abscesses resolved with conservative management. Percutaneous drainage should be considered for lesions >3 cm and in patients who remain persistently febrile, despite culture-specific antibiotics, are immunocompromised or critically ill.ig1"> id="fspara0015a">Representative image of a pediatric renal abscess on computed tomography with intravenous contrast.igure svArticle" id="dfig1" data-t="f">