Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis.

Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

Perinephric abscess.

The clinical condition of perinephric abscess can present dramatically as an acute emergency or insidiously as a chronic condition. The clinical characteristics and contemporary treatment approaches of these different types of perinephric abscess are outlined in this overview of the topic.

Hyperbaric oxygen therapy in a patient with autosomal dominant polycystic kidney disease with a perinephritic abscess.

A 68-year-old female in hemodialysis due to autosomal dominant polycystic kidney disease underwent resection of cysts in her right kidney via a laparoscopic approach due to abdominal pain. Three weeks after surgery, she was admitted with sepsis. A CT scan showed a large abscess around the right kidney. Percutaneous drainage of abscess was performed. The pus smear showed Gram-positive cocci and the culture contained methicillin-resistant Staphylococcus aureus. Ciprofloxacin, clindamycin and vancomycin were given. In the 3 weeks following admission, she remained febrile and septic and showed a progressive deterioration in her general condition, along with malnutrition and persistent drainage of purulent material from her right flank. The antibiotic therapy was changed to vancomycin, metronidazole and meropenem, but no improvement was observed. Because of the high risk associated with carrying out an open nephrectomy, we decided to use hyperbaric oxygen therapy (HBOT) as a potentially useful measure to control her infection. The patient underwent 26 daily sessions of 100% hyperbaric oxygen (2.5 atm). The use of HBOT induced a notable break in the clinical course of this patient's retroperitoneal infection. She was discharged after day 58 without any signs of inflammatory activity, and she has not presented reactivation of infection since then. We think that this case suggests that this therapy could be a new therapeutic tool in the management of patients with similar clinical features when all other therapeutic measures have failed. We did not find any other reports of the use of HBOT in infections of renal cysts.

Renal and peri-renal abscesses in children: proposed physio-pathologic mechanisms and treatment algorithm.

Renal and perinephric abscess in children are uncommon. Three basic pathophysiologic mechanisms are involved, namely, hematogenous spread, ascending infection and contamination by proximity to an infected area. Six pediatric patients diagnosed with renal abscess were treated at our institution from 1990-2000. Five patients were females; ages ranged from 3-17 years (mean 11.8 years). Diagnosis, as expected, was not readily apparent at presentation. Computerized tomography and renal sonograms were the most useful imaging modalities. Gram-negative bacteria were commonly isolated; only one patient grew Staphylococcus aureus. All patients received broad-spectrum intravenous antibiotics. Additional treatments consisted of percutaneous drainage (4 patients), exploratory laparotomy (1 patient, for presumed Wilm's tumor) and nephrectomy (2 patients). A new classification of the etiologic mechanisms of this condition is proposed along with a simple and practical treatment algorithm.

How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall? - A case report.

BACKGROUND: We present a case to illustrate controversies in percutaneous drainage of infected, perinephric haematoma in a tetraplegic patient, who had implantation of baclofen pump in anterior abdominal wall on the same side as perinephric haematoma. CASE PRESENTATION: A 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen to control spasticity. He developed perinephric haematoma while he was taking warfarin as prophylactic for deep vein thrombosis. Perinephric haematoma became infected with a resistant strain of Pseudomonas aeruginosa, and required percutaneous drainage. Positioning this patient on his abdomen without anaesthesia, for insertion of a catheter from behind, was not a realistic option. Administration of general anaesthesia in this patient in the radiology department would have been hazardous. RESULTS AND CONCLUSION: Percutaneous drainage was carried out by anterior approach under propofol sedation. The site of entry of percutaneous catheter was close to cephalic end of baclofen pump. By carrying out drainage from anterior approach, and by keeping this catheter for ten weeks, we took a risk of causing infection of the baclofen pump site, and baclofen pump with a resistant strain of Pseudomonas aeruginosa. The alternative method would have been to anaesthetise the patient and position him prone for percutaneous drainage of perinephric collection from behind. This would have ensured that the drainage track was far away from the baclofen pump with minimal risk of infection of baclofen pump, but at the cost of incurring respiratory complications in a tetraplegic subject.

[Percutaneous drainage of renal and perirenal abscesses. 2 case reports]. / Perkutane Drainage von renalen und perirenalen Abszessen. Zwei Falldarstellungen.

Undetected and untreated renal and perinephritic abcesses are associated with high morbidity and mortality rates. Thanks to the technique of ultrasonography and computed tomography, it is now possible to identify a suspected abscess early on. As treatment, percutaneous drainage has proved both effective and associated with only few side effects. Two cases are reported, one with renal, one with perinephritic abscess, both of which were successfully treated with percutaneous drainage.

Experiencia en el tratamiento del absceso perinefrítico en el servicio de urología y nefrología del Hospital General de México y revisión de la literatura / Experience in the perinephritic abscess treates in the urology and neprhrology service of Hospital General de Mexico and literature review

El absceso perinefrítico es una afección poco frecuente caracterizada por la acumulación de pus en el espacio comprendido entre la cápsula renal y la fascia de Gerota, cuyo curso clínico es insidioso y sus síntomas muy variados, los que hace que su diagnóstico y tratamiento sean retardados. elevándose de esta manera en forma importante su morbimortalidad. Se comunica el acervo de la experiencia obstenida durante ocho años en el tratamiento del absceso perirrenal en el servicio de urología y nefrología del Hospital General de México, SS. Se concluye que el tratamiento más adecuado es el drenaje percutáneo con punción lumbar bajo anestesia local, ya que este método proporciona un control adecuado de la infección, una mejor recuperación de la función renal y un índice bajo de morbimortalidad.

[Anterior perinephritic phlegmon (author's transl)]. / Phlegmon périnéphrétique antérieur.

A case is reported of an unsuspected anterior perinephritic phlegmon which had caused peritonitis of pyelonephritic origin thought to be due to a cholecystitis. The lesion was discovered during laparotomy and intravenous urography at operation demonstrated the condition of the underlying kidney and determined the therapeutic approach and the prognosis.