Perinephric abscess

Last updated: June 27, 2022

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A perinephric abscess is a purulent infection located in the perinephric space between the kidney and the Gerota fascia. It is typically secondary to acute pyelonephritis but may also be caused by the hematogenous spread of bacteria from elsewhere in the body (e.g., in individuals who inject drugs). Risk factors include diabetes mellitus, pregnancy, and urinary tract obstruction or abnormalities. Perinephric abscess typically has an insidious onset, with nonspecific symptoms that include flank or abdominal pain, fever, chills, and dysuria. Costovertebral angle tenderness is often present on examination. Abdominal CT is the preferred method for confirming the diagnosis. Abscess drainage and antibiotic therapy are the cornerstones of treatment. Antibiotic therapy alone may be considered in select patients with small abscesses (< 3 cm). Complications include extension of the abscess beyond the Gerota fascia, into the retroperitoneum (paranephric abscess), then sepsis.

Onset is often insidious and symptoms are nonspecific, but they may include:

Approach [4][5]

  • Suspect perinephric abscess in patients with:
  • Obtain imaging of the abdomen to confirm the diagnosis.
  • Obtain cultures (blood, urine, drainage if possible) to identify the pathogen and guide treatment.

Perinephric abscess is only correctly diagnosed on presentation in approximately one-third of patients. A low threshold for imaging is recommended. [6]

Laboratory studies [4][5]

Routine laboratory studies are not required for diagnosis but may show the following nonspecific findings.

Imaging [4][7]

There is limited recent, high-quality literature on the management of perinephric abscess. Treatment decisions should be made in consultation with urology, interventional radiology, and infectious diseases.

Approach [4][7]

If possible, drain the abscess and obtain cultures prior to starting empiric antibiotics. If drainage is not immediately feasible, start antibiotic treatment without delay.

Management of perinephric abscess is similar to that of renal abscess. For small renal abscesses, there is strong evidence for, and clear guidance on, conservative management. [7]

Antibiotic treatment [4][7][9]

Most recommendations are based on early studies; choose treatment in consultation with a specialist.

Perinephric abscess drainage [4][7]

  • Indicated for most patients for diagnostic and therapeutic purposes.
  • Antibiotic treatment alone may be sufficient for the treatment of small abscesses (< 3 cm). [6][10]
  • Preferred method: percutaneous drainage (guided by CT or ultrasound)
  • Surgical drainage may be indicated in certain situations, e.g.:
    • Percutaneous approach fails or is contraindicated
    • Large abscess
    • Multiloculated abscess

“Ubi pus, ibi evacua” (Latin aphorism): Where there is pus, evacuate it.

We list the most important complications. The selection is not exhaustive.

  1. Lee BE, Seol HY, Kim TK, et al. Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases. Korean J Intern Med. 2008; 23 (3): p.140. doi: 10.3904/kjim.2008.23.3.140 . | Open in Read by QxMD
  2. Balkan II, Savas A, Geduk A, Yemisen M, Mete B, Ozaras R. Candida glabrata perinephric abscess. Eurasian J Med. 2011; 43 (1): p.63-65. doi: 10.5152/eajm.2011.14 . | Open in Read by QxMD
  3. Jacobson D, Gilleland J, Cameron B, Rosenbloom E. Perinephric abscesses in the pediatric population: case presentation and review of the literature. Pediatr Nephrol. 2014; 29 (5): p.919-925. doi: 10.1007/s00467-013-2702-6 . | Open in Read by QxMD
  4. Dembry LM, Andriole VT. Renal and perirenal abscesses. Infect Dis Clin North Am. 1997; 11 (3): p.663-680. doi: 10.1016/s0891-5520(05)70379-2 . | Open in Read by QxMD
  5. Saiki J, Vaziri ND, Barton C. Perinephric and intranephric abscesses: a review of the literature.. West J Med. 1982; 136 (2): p.95-102.
  6. SHU T, GREEN JM, ORIHUELA E. RENAL AND PERIRENAL ABSCESSES IN PATIENTS WITH OTHERWISE ANATOMICALLY NORMAL URINARY TRACTS. J Urol. 2004; 172 (1): p.148-150. doi: 10.1097/01.ju.0000132140.48587.b8 . | Open in Read by QxMD
  7. Rubilotta E, Balzarro M, Lacola V, Sarti A, Porcaro AB, Artibani W. Current Clinical Management of Renal and Perinephric Abscesses: A Literature Review. Urologia. 2013; 81 (3): p.144-147. doi: 10.5301/urologia.5000044 . | Open in Read by QxMD
  8. Mitreski G, Sutherland T. Radiological diagnosis of perinephric pathology: pictorial essay 2015. Insights Imaging. 2017; 8 (1): p.155-169. doi: 10.1007/s13244-016-0536-z . | Open in Read by QxMD
  9. Brook I. Urinary tract and genito-urinary suppurative infections due to anaerobic bacteria. Int J Urol. 2004; 11 (3): p.133-141. doi: 10.1111/j.1442-2042.2003.00756.x . | Open in Read by QxMD
  10. Lee SH, Jung HJ, Mah SY, Chung BH. Renal Abscesses Measuring 5 cm or Less: Outcome of Medical Treatment without Therapeutic Drainage. Yonsei Med J. 2010; 51 (4): p.569. doi: 10.3349/ymj.2010.51.4.569 . | Open in Read by QxMD

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