Treatment of Kidney Abscess

Kidney abscess is an abscess in the corresponding organ, which usually develops as a complication of pyelonephritis (an infection of the renal pelvicalyceal system). This is an infrequent but dangerous pathology that requires surgical treatment. The mortality rate of patients in countries with poorly developed medicine reaches 25%, and the average in the world is 12%. The treatment of renal abscess abroad involves the use of minimally invasive procedures and surgical interventions. They allow not only to cure the disease, but also to do it in the least traumatic way for the patient, while preserving most of the kidney parenchyma.

Content

1. What is kidney abscess
2. Symptoms
3. Diagnostics
4. Surgical treatment
5. Why it is worth undergoing treatment abroad
6. Treatment in Europe with Booking Health at an affordable price

What is kidney abscess

Kidney abscess is one of the most dangerous diseases in urology. This is a bacterial tissue inflammation, in which a cavity with pus is formed. It is limited by a capsule. In most cases, kidney abscess develops as a complication of acute pyelonephritis and mimics the clinical picture of this pathology. Therefore, the diagnosis is not always made on time. However, the tactics of treatment for the abscess is completely different: without exception, all patients require surgical intervention or minimally invasive drainage. With conservative management of patients, severe complications are often common, and the mortality rate reaches 75%.

As a rule, kidney abscesses occur due to improper treatment of pyelonephritis or lack of therapy for this disease. Urinary tract infection progresses, which results in the formation of an abscess. Much less often, the pathology occurs due to trauma, medical manipulation or infection through the blood (against the background of pneumonia or septic endocarditis). Very rarely, it is the result of an infection of tissue that has died as a result of a renal infarction.

In the natural course of pathology, kidney abscess develops in three stages:

• Acute inflammation.
• Purulent fusion.
• Chronic course. 

In most cases, renal abscess forms directly in the kidney. In this case, there is a single abscess. Metastatic abscesses can be multiple and bilateral.

Patients with renal abscess should be promptly treated with surgery. Otherwise, the abscess opens on its own in:

• Perirenal adipose tissue (with the formation of perirenal abscesses or the development of purulent paranephritis).
• Renal pelvicalyceal system (pus enters the urinary tract).
• Abdominal cavity.

In surviving patients, kidney abscess becomes chronic. A dense capsule is formed around the site of infection. This form of the disease can mimic a tumor.

Symptoms

The most common symptoms in patients with renal abscess correspond to the clinical picture of the urinary tract infection: fever, back pain, and possible impurities in the urine.

The clinical picture may be dominated by the signs of intoxication. Fever reaches 40-41 degrees, patients experience a severe weakness, headache, and rapid heartbeat. Patients are inactive and spend most of their time in bed.

An exacerbation of local symptoms may indicate the formation of the abscess in patients with urinary tract infection. Lymph and blood circulation in the kidney are disturbed, tissues swell, and therefore pain syndrome occurs. It increases with tissue palpation. The patients with the abscess often take a forced position with the leg brought to the abdomen on the affected side. An attempt to extend the leg leads to increased pain. The patients with severe pain often have protective tension of the muscles of the anterior abdominal wall.

The appearance of pus in the urine or laboratory determination of bacteria is not an obligatory sign of the infection. Pus can be found in the urine after the abscess breaks through into the urinary tract.

Diagnostics

The main diagnostic method is ultrasound scanning. Ultrasound scanning allows for the detection of a purulent cavity in the kidney. Usually it has a diameter of at least 1 cm. At the site of the abscess, the kidney contour bulges out, and the mobility of the organ is reduced.

Classification of abscesses by diameter is as follows: 

• Up to 3 cm – small.
• Up to 5 cm – medium.
• More than 5 cm – large.

Doppler velocimetry can be conducted as an additional diagnostic method for assessing blood supply to the kidney. The patients with the abscess do not have a vascular pattern in the pathological focus.

In the acute phase of pathology, the mass is usually round, and less dense in comparison with the surrounding parenchyma. In the chronic phase, a dense capsule is found around the abscess. The content inside can be dense or non-uniform (layers of pus and fluid). With a prolonged course of the disease, the capsule shrinks, the mass takes on an irregular shape, and calcium salts are deposited in it.

Depending on the quality of the equipment and the experience of the operator, the accuracy of ultrasound scanning ranges from 70 to 93%.

Computed tomography is a clarifying diagnostic method, which is more informative than ultrasound scanning. It is a contrast-enhanced diagnostic procedure. In patients with mild symptoms or chronic abscess, the CT can reliably distinguish the infection from a tumor. Unlike the tumor, the abscess does not accumulate a contrast agent. The CT scan is the best diagnostic method for multiple or complicated abscesses, as it helps to detect additional perirenal abscesses.

The accuracy of computed tomography is higher than that of ultrasound scanning, and averages 95%.

MRI is rarely used in the diagnostics of the disease, mainly in the presence of contraindications to computed tomography or the introduction of a contrast agent. The accuracy of MRI is comparable to the CT scan.

Laboratory diagnostics is of secondary importance. It detects signs of the urinary tract infection in the urine. Urine and pus culture obtained as a result of abscess drainage helps to identify the causative agent of urinary infection and assess its sensitivity to antibiotics for the optimal choice of antibiotic therapy regimen.

Surgical treatment

The abscess cannot be treated with the use of conservative tactics. The patients with this infection are treated only with invasive methods. One of the following surgical procedures can be used:

• Surgical opening and drainage of the abscess is a classic intervention, which is the main one in countries with poorly developed medicine.
• Surgical removal of the kidney (nephrectomy) is used for the advanced infection.
• Retroperitoneoscopic surgery is performed through short incisions using endoscopic equipment.
• Percutaneous abscess drainage implies pumping out the pus with a thick needle. 

The most sparing method is percutaneous drainage. In this case, no incisions are required. The procedure is performed under the guidance of ultrasound or computed tomography. The doctor inserts a thick needle into the abscess, evacuates the pus, flushes the wound, injects drugs, and leaves a drain tube.

Whenever possible, this is the very first choice of treatment. But not all patients with renal abscess are suitable for this technique. It is used for single, small (up to 5-6 cm) abscesses, convenient for the introduction of a localization needle. The puncture is usually not carried out in the presence of multiple abscesses and after the abscess breakthrough, inflammation of the soft tissues surrounding the kidney. The size of the abscess is not considered a limitation, but if the diameter is more than 6 cm, it may be necessary to implant two drain tubes.

Drainage lasts 8-12 days. The tube is removed after the cessation of pus discharge. All this time, the patient with the urinary tract infection is in the hospital and receives antibiotic therapy.

Benefits of minimally invasive treatment: 

• Low risk of complications.
• Efficiency in developed countries exceeds 90% (in case of failure, doctors can switch to the surgical treatment).
• No general anesthesia required.
• Minimum recovery time. 
• Even patients who are admitted to the urologic clinic in serious condition due to urinary tract infection can receive treatment.
• Abscesses of almost any size can be removed. 

Surgical drainage is an operation that is performed for multiple, bursting, inconveniently located for puncture, or very large abscesses. In the classic version, the surgical intervention is performed through a large incision, but patients have to recover for a long time after such an operation, and the frequency of serious complications reaches 25%.

Therefore, in developed countries, preference is given to minimally invasive retroperitoneoscopic operations. Like laparoscopic ones, they are performed through short incisions. The only difference is that the manipulations are carried out from the side of the retroperitoneal space, but not from the abdominal cavity. This intervention is accompanied by less blood loss, a lower risk of complications, less postoperative pain, and is associated with a faster patient recovery, and a shorter hospital stay.

Why it is worth undergoing treatment abroad

It is better to undergo diagnosis and treatment of urinary tract infections abroad. In developed countries, the methods are less traumatic, more effective, patient mortality and the risk of complications are lower. 

Here are several reasons for you to undergo renal abscess treatment abroad: 

• Accurate diagnosis allows doctors to timely distinguish the pathology from pyelonephritis, tumors, kidney cysts and other diseases.
• Whenever possible, the choice is made in favor of less traumatic interventions: percutaneous kidney drainage or minimally invasive endoscopic surgery.
• Preference is given to organ preservation treatment, while the frequency of kidney removal operations in the world reaches 45%.
• Mortality rate of patients is 1.5 times lower than the average in the world, and 3 times lower than in countries with poorly developed medicine. 

Even the most complex surgical procedures are successfully performed abroad, including for multiple or complicated abscesses that have burst into the urinary tract, perirenal adipose tissue or abdominal cavity. In the vast majority of cases, doctors not only manage to preserve the kidney, but also minimize the loss of the renal parenchyma in order to preserve the function of the organ.

After minimally invasive procedures and operations, patients receive adequate antibacterial and detoxification therapy, symptomatic treatment and full-fledged care.

Treatment in Europe with Booking Health at an affordable price

To undergo treatment of renal and perirenal abscess in one of the European hospitals, you can use the services of the Booking Health company. On our website, you can find out the cost of treatment for renal and perirenal abscess in order to compare prices in different medical facilities and to book a medical care program at a favorable price. Treatment in European hospitals will be easier and faster for you, and the cost of treatment will be lower.

You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide a consultation on treatment in Europe. Booking Health will fully organize your trip to another country. We will provide the following benefits for you:

• We will select the best European hospital, whose doctors specialize in the treatment of renal and perirenal abscess.
• We will solve the problem of the language barrier, and we will take care of communication with the doctor of the European hospital.
• We will reduce the waiting time for the medical care program. You will undergo treatment on the most suitable dates.
• We will reduce the price. The cost of treatment in Europe will be lower due to the lack of overpricing and additional coefficients for foreign patients.
• We will take care of all organizational issues: we will draw up documents, meet you abroad and deliver to the hospital, book a hotel, and provide interpreting services.
• We will prepare a program and translate medical documents. You do not have to repeat the previously performed diagnostic procedures.
• We will help you keep in touch with doctors after the completion of treatment in Europe.
• We will organize additional diagnostic examinations and treatment in European hospitals. 
• We will buy medicines abroad and forward them to your native country. 

Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help reduce the cost of treatment, organize your trip to European hospitals, and you can fully focus on restoring your health.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed