López Alcina E, Arlandis Guzmán S, Monserrat Monfort J J, Fuster Escrivá A, Jiménez Cruz F
Servicio de Urología, Hospital La Fe, Valencia.
Actas Urol Esp. 1999 Feb;23(2):135-9.
Renal and perirenal abscesses are rare infections of the urinary tract traditionally caused by Staphylococcus aureus. Today however there is a predominance of abscesses secondary to coliform bacteria such as E. coli. This paper presents a revision of our series over the last ten years (1987-1996). A total of 11 abscesses (3 renal and 8 perinephritic) were recorded. The most frequent symptom for visiting the clinic was back pain. All patients had predisposing associated conditions. The microbiological analysis revealed E. coli in most abscesses. An HIV+ patient had bilateral renal abscess secondary to Aspergillus fumigatus. CAT appears to be the most specific method for imaging diagnosis, and ultranosography is useful not only to guide percutaneous puncture but also in the follow-up of abscesses after antibiotic treatment. Two renal abscesses resolved with parenteral antibiotic therapy and subsequent observation. Three cases required ultrasound guided percutaneous puncture and intravenous antibiotic therapy. Surgical drainage was required in four. A revision of our experience and the recent literature verified the changes that have taken place in the last few years both in the etiopathogenesis as well as the diagnostic and therapeutical methodology of renal and perinephritic abscesses.
肾及肾周脓肿是一种少见的泌尿系统感染，传统上由金黄色葡萄球菌引起。然而如今，以大肠杆菌等大肠菌群细菌继发的脓肿为主。本文对我们过去十年（1987 - 1996年）的病例系列进行了回顾。共记录了11例脓肿（3例肾脓肿和8例肾周脓肿）。就诊时最常见的症状是背痛。所有患者均有相关易感因素。微生物学分析显示大多数脓肿中存在大肠杆菌。一名HIV阳性患者继发烟曲霉菌感染出现双侧肾脓肿。计算机断层扫描（CAT）似乎是影像学诊断最具特异性的方法，超声检查不仅有助于引导经皮穿刺，还可用于抗生素治疗后脓肿的随访。2例肾脓肿通过肠外抗生素治疗及随后的观察得以治愈。3例患者需要超声引导下经皮穿刺及静脉抗生素治疗。4例患者需要手术引流。对我们的经验及近期文献的回顾证实了过去几年肾及肾周脓肿在病因发病机制以及诊断和治疗方法上所发生的变化。
