Analysis of 17 children with renal abscess

Purpose: This study's aims to analyze the clinical characteristics of children with renal abscess and improve its diagnosis and treatment. Methods: The clinical data of children diagnosed with renal abscess in our hospital from 2007 to 2016 were retrospectively analyzed, including clinical manifestations, laboratory tests, imaging examinations, and treatment measures. Results: 17 children with renal abscess were enrolled with median age was 15 (1.5-163) months old. There were 7 girls and 10 boys. Fever was the most common symptom (82.4%). 58.9% of children suffered from abnormal urogenital function before onset, mainly manifested as ureteral abnormalities (41.2%), renal dysplasia, or non-functioning kidneys (17.6%). Acute C-reactive protein and erythrocyte sedimentation rate (ESR) were increased in more than 85% patients, but the elevation of procalcitonin was not significant (10%). 41.2% of the children had anemia, and 64.7% exhibited markedly elevated leukocytosis. All cases were negative by blood culture. The pathogen was mainly Gram-negative bacteria (47.1%), including Escherichia coli. The detection rate of Enterococcus and Candida albicans was 23.5%. Mycobacterium tuberculosis was found in 1 case. B-ultrasound and magnetic resonance imaging were most commonly used. All cases received anti-infective treatment. 10 cases were ineffective and underwent surgical treatment. There was a significant difference in the treatment outcome between abscesses larger and smaller than 4 cm (P < 0.05). Conclusion: For children with fever, abdominal pain, or flank pain, together with elevated white blood cell count, CRP, ESR, and IL-6, especially when anti-infective effect is poor, renal abscess should be considered. The initial anti-infective treatment of renal abscess can use a step-down scheme. The regimen needs to strengthen the anti-Gram positive bacteria and fungal treatment, and consider the possibility of renal tuberculosis infection. Conservative anti-infective treatment can be used in children with abscess size smaller than 4 cm, while surgery is recommended in abscesses larger than 4 cm not responsive to drug therapy.