Renal abscess in children: Is size an important determinant in deciding treatment options?

IF 0.2 Q4 UROLOGY & NEPHROLOGY
P. Jain, A. Prasad, Rachna Sharma, Sarika Jain
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引用次数: 0

Abstract

Renal abscess (RA) is rarely seen in the paediatric age group. The proposed management protocols are mainly derived from the adult series which may not be appropriate in children. In this retrospective analysis of cases with renal and perinephric abscesses, the objective is to correlate the clinical presentation, radiological findings and treatment options and also to propose a paediatric-specific practical management algorithm. This is a retrospective study of cases with renal and perinephric abscesses admitted between March 2012 and February 2020. The patients were reviewed for demographics, presentation, predisposing factors, laboratory investigations, imaging, management and outcome. Analysis of 12 paediatric patients (13 renal units) with RA (median age 4 years) was done. Organisms were isolated in 8 of 12 (66.6%) patients with Gram-negative organisms being the commonest. On admission, all patients were started on empirical broad-spectrum antibiotics. Except for two patients who were critically ill with frank sepsis and had a tender renal lump, the rest of them were initially offered conservative management with intravenous antibiotics, and the response was reviewed after 48–72 hours. Of five units with abscess size of ⩽3 cm, two units (40%) responded to conservative management, while three units (60%) required intervention, and of eight units of size >3 cm, three units (37.5%) responded to conservative management and five units (62.5%) required intervention. None of the abscesses with perinephric collection (30.7%) responded to antibiotics and required intervention. A protocol based on the size of RA as recommended in most of the adult series may not be appropriate in the paediatric age group because of the differences in clinical presentation, predisposing factors and immune response. The clinical condition on presentation, response to antibiotic therapy and the presence of perinephric collection should be considered as an important determinant in deciding the need for intervention. 4
儿童肾脓肿:大小是决定治疗方案的重要决定因素吗?
肾脓肿(RA)是罕见的,在儿科年龄组。建议的管理方案主要来自成人系列,可能不适合儿童。本研究回顾性分析肾脏和肾周脓肿的病例,目的是将临床表现、影像学表现和治疗方案联系起来,并提出一种儿科特定的实用管理算法。这是一项对2012年3月至2020年2月期间入院的肾脏和肾周脓肿病例的回顾性研究。回顾患者的人口统计学,表现,易感因素,实验室调查,影像学,管理和结果。分析了12例小儿RA患者(13个肾单位)(中位年龄4岁)。12例患者中有8例(66.6%)分离出细菌,其中革兰氏阴性细菌最为常见。入院时,所有患者开始使用经验性广谱抗生素。除2例危重伴明显败血症、肾有压痛性肿块外,其余患者最初均给予静脉注射抗生素保守治疗,48-72小时后复查疗效。在5个脓肿大小为≤3 cm的单位中,2个单位(40%)对保守管理有反应,3个单位(60%)需要干预;在8个大小为≤3 cm的单位中,3个单位(37.5%)对保守管理有反应,5个单位(62.5%)需要干预。无一例肾周脓肿(30.7%)对抗生素有反应并需要干预。由于临床表现、易感因素和免疫反应的差异,在大多数成人系列中推荐的基于RA大小的方案可能不适用于儿科年龄组。临床表现、对抗生素治疗的反应和肾周收集的存在应被视为决定是否需要干预的重要决定因素。4
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来源期刊
Journal of Clinical Urology
Journal of Clinical Urology UROLOGY & NEPHROLOGY-
CiteScore
0.60
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0.00%
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