What is the presentation of perinephric abscess in acute pyelonephritis (kidney infection)?

Updated: Jul 01, 2021
  • Author: Tibor Fulop, MD, PhD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The suppurative material of the abscess is located between the renal capsule and the surrounding renal fascia. The material is secondary to chronic or recurrent pyelonephritis; rupture or extension of a suppurative process from within the kidney; or dissemination (blood, lymph) or direct extension from other sites of infection. Although it is usually confined to the perinephric space, it may extend to the colon, flank, groin, lung (empyema, nephrobronchial fistula), paracervical area, peritoneal cavity, psoas muscle, skin surface, or subphrenic space.

Development is insidious. Presentation may include the following:

  • Fever
  • Chills
  • Unilateral flank pain (70%)
  • Dysuria (40%)
  • Nausea
  • Vomiting
  • Weight loss (25%)
  • Flank tenderness
  • Costovertebral angle tenderness
  • Abdominal tenderness (60%)
  • Referred pain (ie, hip, thigh, or knee)
  • Flank or abdominal mass (< 50%)
  • Pyuria (70%)
  • Sterile urine (40%)
  • Bacteremia (40%)
  • Curvature of the spine away from the involved kidney

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