A renal
abscess is rare in children and diagnosis is not readily apparent before hospitalization, because symptoms are often insidious and nonspecific. To evaluate the diagnostics and
therapy of renal
abscess in the pediatric group, we will report eight cases of renal
abscess in children to illustrate the variable features of this condition. Eight patients, 6 to 156 (mean, 45.9) months old, with renal
abscesses in 9 kidneys were identified. Ultrasound and computed tomography proved to be the most valuable diagnostic tool, revealing a hypoechoic or hypodense mass.
Fever,
abdominal pain, and
leukocytosis were common presenting features, but no child presented symptoms of loin
pain. Escherichia coli was identified in the urine culture among the 6 cases and blood culture in one case. Three children were associated with mild to moderate
vesicoureteral reflux. All patients had an intensive
antibiotic treatment, which led to resolution of the
abscess in eight of the nine kidneys. In one case, the
abscess had to be drained using the CT-guided percutaneous drainage. During follow-up, seven children received
99mTc DMSA renal SPECT and only two of them had complete remission without sequelae of renal
scar. We concluded that the renal
abscesses must be assumed, especially, in children with prolonged
fever,
abdominal pain, and a high value of CRP. Ultrasonography is just a screening test to detect renal swelling, bulging, and enlargement; however, a CT scan is more sensitive and can detect
abscess formation, as well as define the extent of the disease for planning conservative
antibiotic treatment or additional drainage. Finally,
DMSA renal SPECT is the best and the most sensitive examination for detecting the extension area of renal
inflammation and correlated with the renal outcome.