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Renal Abcess:
1. Confined where?
2. Caused by what? 2

1. Abscess that is confined to the kidney and is
2. caused either by
-bacteria from an infection traveling to the kidneys through the bloodstream or
-by a urinary tract infection traveling to the kidney and then spreading to the kidney tissue.


Renal Abscess: Unusual to occur but will generally happen as a result of common problems such as?

1. Kidney inflammation
2. Vesicoureteral reflux
3. Multiple skin abscesses
4. Diabetes mellitus (autonomic nephropathy)
5. Nephrolithiasis
7. Pregnancy
8. Neurogenic bladder


Renal abscess symptoms:

1. Fever
2. Chills
3. Abdominal pain
4. Weight loss
5. Dysuria
6. Hematuria
7. Malaise

Kids like to vomit with renal absesses


Renal abscess – Diagnosis

1. UA
2. CBC
3. Xray
4. Ultrasound
5. CT scan- dont usually want to use die
6. -- Sed rate and CRP
7. DOnt be afraid to get blood cultures early because you may need them later


What will you find in the following in a renal abcess:
1. UA 3
2. CBC
3. Xray- Whats the down side to this?
4. Ultrasound?
5. CT scan?

1. – WBC’s, bacteria, hematuria
2. –Leukocytosis
3. – small abscesses may be difficult to recognize
4. – more helpful than xray. INITIAL TEST!
5. – diagnostic procedure of CHOICE/96% accurate in diagnosing renal abscess.


Renal abscess – Treatment

1. I.V. antibiotics covering causative organism
2. Open drainage in the past
3. Percutaneous drainage is now the more common method
-amp with aminoglycosides
-(amp and gent)


Renal abcess prognosis?

1. Low recurrence rate if underlying cause treated, ex: kidney stones, reflux
2. Diabetes mellitus and advanced renal abscesses may lead to serious disease or death


Acute Pyelonephritis
1. Affects what and spares what?
2. What is characteristic of this?

3. Bacteria infection can result from hematogenous spread or from ascending infection (usually due to predisposing condition)

-Affects cortex with
-sparing of glomeruli and vessels.

2. White cell casts in urine are pathognomonic (always think this if you see casts)


What kind of bacteria causes Acute Pyelonephritis usually:
1. Most common?
2. Others? 3

1. Usually: E. coli

2. Also: Proteus, Klebsiella, and Enterobacter.


1. Acute Pyelonephritis general prognosis?
2. If coexistent renal disease is present what may result?
3. Inadequate therapy could result in what?

1. Healthy Adults usually recover complete renal function.

2. If coexistent renal disease is present, scarring or chronic pyelonephritis may result.

3. Inadequate therapy could result in abscess formation


Acute pyelonephritis:
1. Emphysematous pyelonephritis is what?

2. The majority of these pts will have what?
3. If they dont what will they have? 2

4. Without early therapeutic intervention this condition becomes rapidly progressive, generalizes to what?

5. What is the prognosis?

1. life-threatening necrotizing infection of the kidneys characterized by gas formation within or surrounding the kidneys.
2. poorly controlled DM
3. Non DM patients are usually immunocompromised or have associated urinary tract obstruction due to lithiasis.

4. fulminant sepsis

5. carries a high mortality rate.


Acute pyelonephritis Symptoms

1. Shaking chills
2. High fever
3. Arthralgias
4. Myalgias
5. Flank pain with CVA tenderness


What are two situations that cause neurogenic bladder?

1. pregnancy
2. MS


Acute pyelonephritis

1. UA
2. CBC
3. Blood culture may also be positive
4. Ultrasound
5. CT scan


Acute pyelonephritis
Diagnosis what will be seen on the following:
1. UA? 3
2. CBC? 1
3. Ultrasound? 1
4. CT scan? 2

1. WBC’s, bacteria, hematuria

2. Leukocytosis with left shift

3. may show hydronephrosis from a stone or other source of obstruction

4. diagnostic procedure of choice – may show hydronephrosis and attenuation caused by inflammation/infection.


Acute pyelonephritis
1. Severe or complicating factors may require what?
2. What may be necessary in the case of urinary retention?
3. What may be required if there is ureteral obstruction?

4. What are required to determine antimicrobial sensitivity?

1. hospital admission

2. Catheterization
3. Nephrostomy drainage

4. Blood and/or urine cultures


Acute pyelonephritis
1. Treatment: Common antibiotics used? 4

2. How long are they given?

3. Follow-up treatment includes?

4. Patients at high risk of recurring urinary tract and kidney infections are?

-I.V. – Ampicillan
-P.O. – Ciprofloxin, Ofloxacin, Bactrim DS

2. Antibiotics are given for 21 days.

3. re-culturing urine several weeks after drug therapy is finished to rule-out re-infection.

4. –indwelling catheters – require long-term follow up.


1. Chronic pyelonephritis is caused by?

2. Occurs almost exclusively in patients with major anatomical anomalies such as? 4 (most commonly?)

3. 30-40% of young children with UTI’s have what?

1. Caused by renal injury induced by recurrent or persistent renal infection

-Urinary tract obstruction
-Struvite calculi
-Renal dysplasia
-Vesicoureteral reflux (VUR) – most commonly

3. VUR


Definition of VUR?

Normally the ureter has antireflux action by? 2

It is one of the most common problems encountered by pediatric urologist.

1. Retrograde flow of urine from the bladder to the upper urinary tract.

1- actively by trigonal muscle contraction
2- passively by flap valve mechanism


1. 70% of infants presenting a with UTI have what?

2. More in what gender?
3. Who is it more serious?

4. Genetic predisposition is positive in up to what percent of pts?

1. VUR

2. Female >male.

3. Usually male has higher grade VUR than females.

4. 40%.


Primary etiology of VUR?

1. Congenital deficiency in the longitudinal muscle fibers in ureterovesical junction
2. Altering the normal ratio of length: width from 5: 1 down to 1.4 :1


Secondary etiology of VUR?

1. Bladder outlet obstruction at the posterior uretheral valve or stenosis
2. Functional obstruction eg. Neurogenic and non neurogenic bladder dysfunction


VUR Clinical presentation
1. In a newborn?
2. Older children?
3. Prenatally?

1. In newborn: usually non specific manifestation such as failure to thrive, difficult feeding, or lethargy.

2. Older children: flank pain or abdominal pain , fever.

3. Prenatally diagnosed by US with abdominal swelling (late finding)


VUR Workup
1. Urinalysis? 2
2. Standard VCUG and US are required in? 3

1. (for significant colony count)
>100,000 count in mid-stream sample
>10,000 in catheterized or aspirated urine sample

1- child less than 5 yr with UTI
2- any male child with a UTI
3- febrile UTI


Prognosis of VUR
Resolves spontaneously before adolescence in: 5

1. 90% of Gr. 1 reflux
2. 80% of Gr. 2
3. 50% of Gr. 3
4. 10% of Gr. 4
5. 0 in Grade 5 reflux


1. Kidney is most susceptible to what?

2. Scars develop less frequently after what age?

3. VUR and scarring lead to what? 2

1. scarring in the first year of life and at the time of first upper tract infection.

2. 5

3. VUR and scarring lead to
-progressive renal insufficiency and failure.


1. Chronic pyelonephritis
is associated with what?

2. May occur in utero with what?

3. UTI’s also induce renal injury, which heals with what?

4. Infection without reflux is less likely to do what?

1. Associated with progressive renal scarring, which can lead to ESRD

2. renal dysplasia, although dysplasia may also be caused by obstruction

3. scar formation.

4. produce injury


Chronic Pyelonephritis
1. What does the scarring look like?
2. What happens to the kidney?

3. WHat are seen in the tubules?

4. Whats the acronym to remember this? 4

1. Coarse, asymmetric corticomedullary scarring.

2. Thyroidization of the Kidney (filled with colliod casts)

3. Eosinophilic casts seen in tubules

4. Chronic Pye and
T - Thyroidization
E - Eosinophilic Casts
A - Assymetric Scarring


Symtpoms of Chronic pyelonephritis?

1. Fever
2. Lethargy
3. Nausea and vomiting
4. Flank pain or dysuria
5. Some children may present with failure to thrive


Diagnosis of chronic pyelonephritis?

1. UA
2. Urine Culture
3. Imaging-IVP