An
abscess may form in the renal parenchyma as the result of blood-borne spread of
organism, especially coliform or Staphylococcus
aureus. Occasionally the condition results from infection of a haematoma
following a blow to the kidney. Renal carbuncle is most commonly seen in
diabetics, intravenous drug abusers, those debilitated by chronic disease and
patients with acquired immunodeficiency.
Pathology
The
renal parenchyma contains an encapsulated necrotic mass.
Clinical features
There is an ill-define tender swelling in
the loin, persistent pyrexia and leukocytosis, signs that closely simulate
those of perinephric abscess. In early cases there is no pus or bacteria in the
urine, but these appear later. The space occupying lesion in the kidney may be
confused with a renal adenocarcinoma.
Treatment
Resolution
by antibiotic treatment alone is unusual. Formal open incision of the abscess
may be necessary if the pus is too thick
to be drained by percutaneous aspiration.
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