Renal abscess: Early diagnosis and treatment

The purpose of this study was to identify initial clinical characteristics that can lead to early diagnosis of renal abscess in the emergency departme nt and predict poor prognosis. A retrospective review of 88 renal abscess p atients, from April 1979 through January 1996, was conducted. Patients were categorized into two groups. In group 1, renal abscess was diagnosed by an emergency physician, whereas in group 2 renal abscess was not diagnosed by an emergency physician. Clinical; characteristics included demographic dat a, predisposing medical problems, duration of illness before diagnosis, tim e spent in hospital diagnosis, initial signs and symptoms, laboratory tests , and radiology studies that may have been useful in the early diagnostic r egimes. Clinical factors were also analyzed for their value in predicting p oor prognosis. The mean age of 88 patients with renal abscess was 59.8 year s. The most common predisposing disorder was diabetes mellitus, followed by renal calculi and ureteral obstruction. The duration of diagnosis by emerg ency physicians was shorter for group 1 patients (1.2 +/- 4.4 v group 2, 2. 8 +/- 2.9 days; P < .01) and the blood urea nitrogen level was higher in gr oup 1 (55.7 +/- 42.2 mg/dL, v group 2, 33.5 +/- 33.5 mg/dL; P = .02), In th e early diagnosis of renal abscess, emergency physicians should focus on pa tients who have predisposing disorders, ie, diabetes mellitus, renal stones , immunosuppression, longer duration of symptoms of urinary tract infection , and renal failure, who should promptly be investigated with ultrasound in the emergency department. The cure rate after treatment with routine antib iotics plus percutaneous drainage was 64%. This therapy is recommended for initial treatment. Poor prognosis is associated with elderly patients with lethargy and with elevation of the serum blood urea nitrogen level. Copyrig ht (C) 1999 by W.B. Saunders Company.