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We report a case of retroperitoneal emphysema caused by a renal abscess. A 45-year-old man with underlying type 2 diabetes mellitus visited the emergency department with right flank pain and a fever. On physical examination, right costovertebral tenderness in the ipsilateral flank was noted. Leukocytosis and high inflammatory marker levels were observed. Urinalysis showed pyuria and glucosuria. Urine culture was positive for Streptococcus agalactiae. A computed tomography scan of the abdomen showed a focal, lowattenuation lesion in the right kidney with a 3 cm, exophytic, high-attenuation lesion in the right kidney upper pole and gas-containing fluid collection within the retroperitoneal space. The diagnosis was retroperitoneal emphysema caused by a renal abscess. As the vital signs were stable and the patient refused puncture, we decided on a course of antibiotics alone with follow-up without percutaneous drainage or surgery. The patient improved without any complications. This is a rare case of a renal abscess penetrating the renal fascia and progressing to a posterior paranephric emphysema. The patient was treated with antibiotics alone and cured successfully. Early diagnosis and proper treatment are needed, and percutaneous drainage or urgent surgery would be beneficial for such cases depending on the patient's condition.

Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in specific regions, including Southeast Asia and Northern Australia. In Japan, where no autochthonous has been reported to date, melioidosis is a rare infectious disease. Herein, we report a case of melioidosis in a 68-year-old Japanese man with renal abscess and bacteremia, but without pneumonia. The patient presented to our hospital and was admitted for fever and chills that have persisted for two months. It was speculated that he was infected in Thailand, where his family lives because he shuttled between Thailand and Japan. Blood cultures on admission identified Burkholderia species; however, the species was unidentifiable by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Further re-examination, including culture, loop-mediated isothermal amplification, and multiplex polymerase chain reaction methods, finally identified Burkholderia pseudomallei. We treated the patient with intravenous ceftazidime for four weeks. In addition to the antibiotics administration, puncture drainage of the renal abscess was performed, and he gradually became afebrile. Intravenous ceftazidime was switched to oral sulfamethoxazole/trimethoprim on post-admission day 32, and he was discharged. After five months of oral sulfamethoxazole/trimethoprim, no recurrence was observed one year after discharge. To diagnose melioidosis, especially in non-endemic areas, a precise and thorough understanding of its epidemiology, presentation, and identification methods is necessary.

Xanthogranulomatous pyelonephritis (XGPN) is a rare disorder affecting the kidney which can fistulise to the colon in exceptional cases. We herein report a case of XGPN with renocolic fistula and large vessel thrombosis presenting with sepsis and pulmonary embolism. Preoperative diagnosis and strategic planning resulted in successful management. A 64-year-old woman presented to the emergency department with abdominal pain and a septic condition, corroborated by venous thromboembolism. Workup diagnosed a left renal abscess with calicocolic fistula. Scintigraphy confirmed a nonfunctioning left kidney. The patient underwent inferior vena cava filter placement and staged surgery. The first, damage control procedure was a loop ileostomy. Ten days later, when the patient’s conditions improved, she underwent left nephrectomy and left colectomy with primary anastomosis. Finally, a year later, the ileostomy was closed. At follow-up, the patient was well, with unremarkable renal function. Scrupulous diagnostics, multidisciplinary decision making, and staged intervention have been key to optimal outcome.

Renal and pararenal abscesses are rare but serious diseases that result from infection of kidneys or tissues around them. This article examines a clinical case of renal and paranephric abscess, presents modern data on the etiology of the disease, types of abscesses, and describes the mechanisms and risk factors for the development of renal and pararenal abscesses, as well as the main diagnostic measures.

Background: Imaging plays a very important role in the diagnosis of renal infection. It assists diagnosis and differentiates between different types of renal infection. It also helps to detect and manage the associated complications through image-guided drainage and aspiration. Contrast-enhanced CT is the most useful study. A contrast-enhanced study is essential for a complete evaluation of patients with renal inflammatory disease to demonstrate alterations in the renal parenchymal perfusion and excretion of the contrast material, which occur as a result of the inflammatory process. Objective: To detect the role of multidetector CT in diagnosis of renal infection. Materials and methods: This prospective study was conducted on sixty patients. The study was carried out at Diagnostic Radiology Departments of Menoufia University Hospital. The patients were presenting with fever (< 38°C) mainly and loin pain. Results: From 60 patients with renal infection, 18 cases were diagnosed as pyonephrosis, 16 cases were diagnosed as renal abscess, 12 cases were diagnosed as pyelonephritis, 4 cases were diagnosed as xanthogranulomatous pyelonephritis, 4 cases were diagnosed as perinephric abscess, 2 cases were diagnosed as emphysematous pyelonephritis, 2 cases were diagnosed as fungal ball, 2 cases were diagnosed as urinoma. The mean age was (39.4 ± 15.7). Conclusion: Contrast enhanced computed tomography is a perfect diagnostic modality to assess the severity of inflammatory process and reaching the diagnosis of renal infection. It also helps to reach the cause, predisposing factors, associations, complications and the extent of the disease.

Acute Lobar Nephronia (ALN) is a rare infective condition of the kidney currently described only in case reports and small case series. The diagnosis of ALN is made by characteristic clinico-radiological findings. Differentiation from acute pyelonephritis, renal abscess and renal tumor is crucial for proper management and to avoid unnecessary diagnostic interventions. Herein, we report a 58-year-old woman with an uncontrolled diabetes mellitus, who was diagnosed clinically as acute pyelonephritis and treated with standard duration of antibiotics but had recurrence of symptoms. On evaluation, she was found to have ALN which was treated successfully with prolonged antibiotic course.

Renal abscess and nephronia are uncommon diseases in children and with unknown global prevalence. Nephronia represents an intermediate state between pyelonephritis and renal abscess. Prompt diagnosis is important to prevent morbidity and mortality (sepsis, renal injury, death). Scientific advances have made these entities more evident, although they may still be underdiagnosed. Patients with this disease require prolonged intravenous antibiotic therapy and potentially surgical resolution, mostly when their size is bigger than 3 - 5 cm when therapy with intravenous antibiotics alone fails and they are accessible to percutaneous drainage. We describe five cases of pediatric patients from four private hospitals in Quito, Ecuador followed during a one-year period. In every case, the diagnosis was suspected mostly because of persistent fever, abdominal pain, severe leukocytosis and/or elevated inflammation biomarkers. Only one of them had a previous history of urinary tract malformation while in another one malformation was revealed in his actual admission. Every case had microbiologic isolation. All of them recovered successfully. To our knowledge, in our country, there are no previous reports of these diseases in pediatric patients, and worldwide, there is scarce data. Our aim is to alert doctors who work with children to be aware of this condition.

Background and Objective: Urinary tract infections (UTIs) are one of the most commonly reported infections worldwide. The diagnosis of these infections is primarily based on clinical symptoms and biochemical data. Diagnostic imaging plays an important role in the management of UTIs. The main objective of this prospective study was to evaluate and compare of sensitivity and specificity of ultrasonography and computed tomography examination in the diagnosis of UTIs.Patients and Methods: In this study, we examined 100 cases (48 males and 52 females of varying age groups) referred with clinical suspicion of urinary tract infection to the department of radiodiagnosis, KIMS Hospital, Bangalore. After history taking and clinical examination all patients underwent urine analysis, ultrasound, and computed tomography (CT) examination. Results: Uncomplicated cystitis followed by acute pyelonephritis (APN) was the most common type of UTI as per the results. The sensitivity and specificity of ultrasound in diagnosing uncomplicated cystitis were 88.57% and 100%, respectively, whereas, that of CT was 74.29% and 100%. The sensitivity and specificity of ultrasound in diagnosing APN were 64.51% and 100%, respectively, whereas, that of CT were 90.32% and 100%. Sensitivity and specificity of CT in diagnosing chronic pyelonephritis, renal abscess, and emphysematous pyelonephritis remained 100% throughout.Conclusion: Ultrasound was found to be a more sensitive investigation in cases of uncomplicated cystitis than CT. CT on the other hand was found to be more sensitive and specific in the diagnosis of UTI and its complications other than uncomplicated cystitis.

Renal abscesses are rare and mainly caused by an ascending infection due to Gram-negative microorganisms. We report the first case of a renal abscess caused by Panton-Valentine leukocidin-producing...

Acute pyelonephritis is a bacterial infection of the renal parenchyma and collecting system. Diagnosis is based on clinical findings of fever, flank pain, and urinary tract infection. Computed tomography findings include renal enlargement with wedge-shaped heterogeneous areas of decreased enhancement, known as a "striated nephrogram." Imaging is primarily used to diagnose complications such as emphysematous pyelonephritis, renal abscess, and pyonephrosis. Chronic pyelonephritis can have varying appearances on imaging ranging from xanthogranulomatous pyelonephritis or, in extreme cases, renal replacement lipomatosis.

Perinephric and renal abscess are very rare entities with insidious presentation and pose a great diagnostic challenge, common etiology being bacterial. Only less than 30 cases of fungal etiology have been reported in literature. Herein, we report first case of fungal perinephric abscess caused by Candida tropicalis in a young diabetic female who presented with right flank pain and vomiting. Diagnosis made by CT imaging and culture of USG guided aspiration of perinephric abscess revealed growth of Candida tropicalis. Candida tropicalis perinephric abscess requires a very high index of suspicion for diagnosis. Associated high morbidity and mortality rates are likely due to misdiagnosis, therefore fungal perinephric and renal abscess must be kept as differential diagnosis in cases of fever with abdominal pain. Prompt diagnosis and early treatment are important for better outcome. Imaging and microbiological investigations are required for diagnosis, and drainage is indicated for successful therapy.

Acute renal infection or acute pyelonephritis (AP) denotes the process of inflammation of the renal parenchyma and its collecting system and the urothelium following infection. Uncomplicated AP commonly affects otherwise healthy, young women without structural or functional urinary tract abnormalities and without relevant comorbidities. More severe and complicated AP occurs in patients with a structurally or functionally abnormal genitourinary tract, or in persons with a predisposing medical condition like immune compromised state and diabetes. Complicated AP is characterized by a broader spectrum of clinical presentations, a wider variety of infecting organisms, and a greater risk of progression to a complication, such as intrarenal or perinephric abscess or emphysematous pyelonephritis and has the capacity to damage the organ and at times maybe life threatening. Role of imaging in renal infection is secondary, and in most situations, imaging is done to confirm the clinical diagnosis, map progression of disease in immune-compromised group of patients, or to evaluate for potential complications and therapeutic interventions. This article attempts to discuss the pathophysiology of AP from the standpoint of medical imaging and also brings out illustrative examples of various manifestations of AP and its complications. It provides imaging insight into various stages of inflammation, development of complication, and a roadmap for understanding AP through cross-sectional imaging.

Wilms' tumor (WT) is the most common renal malignancy in children. Its clinical and radiologic presentation may mimic other pediatric renal diseases, including pyonephrosis or renal abscess. The authors report a case of a 3-year-old girl presenting with pyelonephritis and right renal mass suggestive of a renal abscess, not responding to antibiotics. Further investigations were conducted, including a percutaneous renal needle core biopsy. A stage I fully necrotic WT was finally diagnosed. This amazing case of a fully necrotic WT at diagnosis demonstrates the importance of anatomopathologic analyses in pediatric renal masses, even when the infection is suspected.

Diabetes is very common predisposing factor for UTI. The fact that asymptomatic bacteriuria is more common in females with diabetes as compared to males with diabetes. Asymptomatic bacteriuria (ASB) is defined as When a bacterial count of same species over10^5 per ml in mild stream clean catch specimen of urine on two occasion is detected without the symptom of urinary infection. Significant bacteriuria detected by urinary culture, without symptoms attributable to urinary tract like burning micturition, frequent micturition, urinary incontinence, urgency, painful micturition, suprapubic pain, flank pain or fever. Asymptomatic and symptomatic bacteriuria are more common in females with diabetes. Asymptomatic bacteriuria may be precursor for symptomatic bacteriuria. The UTI ranges from asymptomatic bacteriuria to lower cystitis, pyelonephritis, xanthogranulomatous pyelonephritis, renal abscess, perinephric abscess, and papillary necrosis. Asymptomatic bacteriuria seems to be non eradicable, recurring in case of diabetic females.

Emphysematous pyelonephritis (EPN) is a rare life-threatening gas producing kidney infection, commonly affects uncontrolled diabetic patients with underlying urinary tract obstruction. Presence of pneumoperitoneum and involvement of the bowels are uncommon presentation of EPN. In the present report, we present a 59-year-old African male who had extensive EPN with pneumoperitoneum, pneumatosis intestinalis and extension to the bowel causing ischemia. Successful surgical exploration was done, with resection anastomosis of the ischemic bowel segment and drainage of the kidney.

Staphylococcus saprophyticus is second only to Escherichia coli as the most frequent causative organism of uncomplicated urinary tract infections (UTIs) among the sexually active female population. However, it is considered a rare cause of complicated UTIs in immunocompetent hosts with no identifiable risk factors for the occurrence of a complicated urinary tract infection. We report an exceedingly rare case of a 20-year-old otherwise healthy female patient, with no identifiable risk factors for complicated UTIs, who presented with a recurrent renal abscess secondary to S. saprophyticus. Serial cultures from multiple sources were negative, and the culprit organism was identified by a polymerase chain reaction (PCR) analysis of the drained pus that identified the 16 s rDNA sequences of S. saprophyticus on serial occasions. To our current date, similar cases have been rarely reported in the available literature. Our case also highlights the diagnostic value of molecular biology techniques in the identification of causative pathogens in cases of culture-negative infections when conventional microbiologic tests fail to isolate the culprit organisms. Clinical microbiology studies are needed to further explore the exact possible interactions between bacterial-specific characteristics and host-related factors that may explain the occurrence of the complicated UTIs that are associated with S. Saprophyticus among patients who are not considered to have certain risk factors that would usually predispose to complicated UTIs.

Renal and perinephric abscesses are rare but severe infections of urinary tract. It may have atypical causes and requires usually an emergency management. A young patient presented with right flank pain, fever and chills was diagnosed with a large renal abscess ruptured in perinephric space. He underwent successful percutaneous drainage guided by both ultrasound and computed tomography of the abdomen. The concept of percutaneous route and the role of imaging, particularly ultrasound, in managing such emergencies are discussed alongside with a review of current literature. Section headings Inflammation and Infection.

Urogenital tuberculosis is the commonest extrapulmonary tuberculosis after lymphadenitis, with the kidneys being the most frequently affected organ. The clinical manifestation of renal tuberculosis is frequently nonspecific, leading to many overlooked cases especially in a developed country. Herein, we report a case of renal tuberculosis in a 79-year-old Caucasian lady who presented with recurrent renal abscess refractory to antibiotics. Level of evidence: Level 5

Urinary tract infection (UTI) affects patients of all ages and is a diagnosis that emergency physicians might make multiple times per shift. This article reviews the evaluation and management of patients with infections of the urinary tract. Definitions of asymptomatic bacteriuria, uncomplicated UTI, and complicated UTI are presented, as well as techniques for distinguishing them. The pathophysiology and clinical and laboratory diagnoses of UTI are described. Treatment of UTI is reviewed, with attention to bacteriuria and special populations, including pregnant, elderly/geriatric, and spinal cord injury patients.

We report the first case of microabscesses detected by polymerase chain reaction (PCR) amplification of nucleic acid from ultrasound-guided aspirated fluid in a three-year old boy with acute lymphoblastic leukemia and febrile neutropenia during induction chemotherapy. Fever persisted despite effective antifungal treatment. The addition of corticosteroid therapy successfully controlled the suspected immune reconstitution inflammatory syndrome (IRIS). This case highlights the utility of PCR and adjunctive corticosteroid in the approach of Candida tropicalis renal microabscesses in leukemic patients undergoing chemotherapy. Keywords: Renal abscess, Candida, Leukemia, Nucleic acid amplification, Polymerase chain reaction

Resumen Introducción. Los abscesos renales tras una infección urinaria en pediatría no son frecuentes. Reporte de los casos. Se trata de dos niñas con infección urinaria, de 13 y 8 meses, que desarrollan abscesos renales. En ambas, después de un uroanálisis sugestivo de infección urinaria, se inicia manejo empírico con amikacina. El reporte del urocultivo muestra crecimiento de Escherichia coli (E. coli) >100 000 UFC/ml, sensible a dicho antibiótico, con ecografía renal inicial normal en el primer caso y en el segundo con nefromegalia derecha. A pesar del manejo antibiótico persistió la fiebre por más de tres días, por lo que se sospecha una complicación supurada. En el primer caso, la ecografía renal de control refleja imágenes sugestivas de absceso renal, pero en el segundo, a pesar de ecografías seriadas, solo se reportó la nefromegalia, que llevó realizar una tomografía abdominal con contraste para confirmar el diagnóstico. El antibiótico inicial, a pesar de la sensibilidad in vitro, no fue capaz de controlar la formación de abscesos renales. En el primer caso, el proceso infeccioso se controló utilizando amikacina y ceftriaxona, pero en el segundo fue necesario meropenem y amikacina. En ningún momento se alteró la función renal. Es de anotar lo infrecuente que es el absceso renal en niños en nuestra institución, ya que no se ha encontrado ningún caso en varios años. Conclusiones. El absceso renal en pediatría no es frecuente, se desarrolla principalmente tras una infección urinaria. Son necesarios una alta sospecha y un adecuado diagnóstico para orientar su manejo, ya sea solo médico o asociado a drenaje quirúrgico. Summary Introduction: Renal abscesses are not common in pediatrics after urinary tract infections. Case reports: The two cases involve two 8 and a 13 month old girls with urinary tract infections, who also develop renal abscesses. In both cases, after a urinalysis shows signs of urinary tract infections, empirical management with amikacin is initiated. The uroculture report shows a growth of Escherichia coli (E. coli) >100,000 CFU/ml, sensitive to the given antibiotic, with a normal initial renal ultrasound in the first case and right nephromegaly in the second case. Despite the antibiotic treatment, the fever persisted for more than three days, which is why a suppurative complication is suspected. In the first case, the renal ultrasound from the control suggests the presence of a renal abscess, but in the second case, despite serial ultrasounds, only nephromegaly was reported; therefore, an abdominal tomography with contrast was performed in order to confirm the diagnosis. The initial antibiotic, despite in vitro sensitivity, was not able to control the formation of renal abscesses. In the first case, the infectious process was controlled using amikacin and ceftriaxone, but in the second case, meropenem and amikacin were necessary. At no point in time did the renal function change. It is important to note how infrequent renal abscesses in children are in our institution, given that there have not been any reported cases for several years. Conclusions: Renal abscesses in pediatrics are not frequent; they develop mainly after a urinary tract infection. A high level of suspicion along with an adequate diagnosis is needed in order to guide its management, be it only medical or associated with surgical drainage. Resumo Introdução. Os abscessos renais após uma infeção urinária em pediatria não são frequentes. Relatório dos casos. Trata-se de duas meninas com infeção urinária, de 13 e 8 meses, que desenvolvem abscessos renais. Em ambas, após uma análise de urina sugestiva de infeção urinária, se inicia manejo empírico com amika-cina. O relatório da cultura de urina mostra crescimento de Escherichia coli (E. coli) >100 000 UFC/ml, sensível a este antibiótico, com ultrassonografia renal inicial normal no primeiro caso e no segundo com nefromegalia direita. Apesar do manejo antibiótico persistiu a febre por mais de três dias, motivo de suspeita de uma complicação supurada. No primeiro caso, a ecografia renal de controle reflete imagens sugestivas de abscesso renal, mas no segundo, apesar de ultrassonografias seriadas, só foi reportada a nefromegalia, que levou a realizar uma tomografia abdominal com contraste para confirmar o diagnóstico. O antibiótico inicial, apesar da sensibilidade in vitro, não foi capaz de controlar a formação de abscessos renais. No primeiro caso, o processo infecioso foi controlado utilizando amikacina e ceftriaxona, mas no segundo foi necessário meropenem e amikacina. Em nenhum momento foi alterada a função renal. Vale anotar que o abscesso renal em crianças em nossa instituição é pouco frequente, já que não há registro de caso algum em vários anos. Conclusões. O abscesso renal em pediatria não é frequente, se desenvolve principalmente após uma infeção urinaria. É necessário uma alta suspeita e um adequado diagnóstico para orientar seu tratamento, seja somente médico ou associado à drenagem cirúrgica.

Background and Purpose: Fungal renal abscesses are rare entities associated with significant morbidity and mortality. Affected kidneys can have microabscess, pyelonephritis, pyonephrosis, or papillary necrosis. Case report: Herein, we reported an unusual case of a large renal abscess cause by Candida tropicalis in a diabetic patient. The entity presented as a lump in the abdomen and later was diagnosed to be an abscess on computed tomography scan. Candida tropicalis was confirmed on the culture of the aspirate. The abscess was successfully treated by percutaneous drainage and administration of amphotericin B deoxycholate. Conclusion: Candida tropicalis is now a global concern because of its rising prevalence and high virulence. The growing resistance of this Candida species to azoles, as in our case, calls for a more judicious usage of antifungal agents. Empirical therapy with either amphotericin or echinocandins is an option in case of high azole resistance. This case highlights the importance of timely diagnosis and implementation of aggressive management in cases suffering from fungal abscesses.

Staphylococcus aureus rarely causes pyelonephritis or cystitis in children. S. aureus-induced urinary tract infection usually develops after an instrumentation or secondary causes such as renal abscess, osteomyelitis or bacterial endocarditis. Additionally, urinary tract colonization by S. aureus may also be the source of staphylococcal bacteremia associated with urinary tract abnormalities and vesicoureteral reflux. Here, a 5-year-old boy with urinary tract anomaly detected S. aureus in both blood and urine cultures. Diagnosis and treatment process of the patient were presented.

The treatment of patients with renal intra-diverticular stones with minimal invasive surgery is always a challenge for the surgeon. We present here a report of a case of pure laparoscopic nephrolithotomy and another with a robotic approach for multiple calculi in renal calycenal diverticulum in two young female patients, previously treated by unsuccessful ureteroscopy in addition to two previous lumbotomies in one of the patients due to renal abscess.

A 5-year-old boy was diagnosed with left acute focal bacterial nephritis (AFBN) complicated with renal abscess (RA) on magnetic resonance imaging (MRI). MRI is useful for diagnosing AFBN and RA complications. He was administered antibiotics for 3 weeks on evaluation of MRI findings. Evaluation of apparent diffusion coefficient values over time may be useful as an index of treatment of RA.

Streptococcus agalactiae (Group B Streptococcus or GBS)is an exceptionally rare causative organism of a ruptured renal abscess. We report a case of this normally commensal organism causing a large ruptured renal abscess in a 17-year-old postpartum female. Although S. agalactiae is known to cause postpartum neonatal morbidity and mortality, it has rarely caused invasive infections in the last 20 years in adults. While this diagnosis often presents with nonspecific findings that can easily be overlooked during the postpartum period, the patient responded well to the established treatment of broad-spectrum antibiotics and a percutaneous drain.

Introduction: We aimed to evaluate the size reduction and complications after transcatheter embolization of renal angiomyolipomas (AMLs). Methods: Cases from a single tertiary center were analyzed retrospectively. A blinded radiologist provided measurements of AMLs using a combination of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Electronic clinical notes, radiographic imaging, and laboratory data were reviewed. Results: Twenty-one embolization procedures from 2002–2019 were analyzed. Four cases were emergency, the remainder elective. The average followup time after intervention was 42 months. Techniques included ethanol, PVA, Gelfoam, Embospheres®, Histacryl®, and coils. The median diameter size of AMLs was 8.6 cm pre-procedure and 6.0 cm post-procedure. The median volume of AMLs was 200 cc pre-procedure and 67 cc post-procedure, with a median reduction in volume of 55%. One case (4.8%) had a re-embolization and three cases (14.3%) proceeded with surgical management of the AML. No cases re-presented with bleeding. Post-embolization syndrome is common. Renal arterial dissection and renal abscess are infrequent complications (9% and 4.5%, respectively). There was no treatment-based mortality. Conclusions: Embolization for renal AMLs is an established, safe, and effective method of treatment and our series further supports that. Determining when to intervene and how long to follow up patients is an issue that has not been well-described; more research needs to be done in this area.

Renal abscess, the accumulation of infected fluid in the kidney, is a rare condition seen in children as well as adults. It leads to long term hospital admission and antibiotic use. Early diagnosis is an important factor in the outcome of renal abscess because the management may differ. Urinalysis test results and radiologic imaging findings of the patients who are admitted to hospital with complaints of fever, vomiting, abdominal pain or flank pain are important for the early diagnosis. Undertreated cases have high risk for renal scar formation. In this paper, we aim to present three pediatric patients, who showed the complication of renal abscess and were treated with long term antibiotic use without a need for surgical drainage.

Introduction: The Coronavirus disease-2019 (COVID-19) has been declared as a pandemic in March 2020 by the World Health Organization (WHO). Since then, this pandemic has dramatically affected the entire world, even radically influencing the way patients are framed at triage. Symptoms and tests in most cases lead to a correct diagnosis; however, error may be around the corner. Case report: A 60 years old patient was referred with weight loss, fatigue and mild fever for 3 weeks as he was working in a COVID-19 ward. After a positive swab and chest CT scan, he was admitted in the hospital and treated as mild COVID-19 patient. A CT scan performed after the patient was discharged revealed a renal lesion misidentified as a tumor then clarified to be an abscess which retrospectively appears to be the main cause of his symptoms. Conclusion: Clinicians should consider other life-threatening disease in the differential diagnosis of patients presenting with similar symptoms to minimize mistakes and avoid further unnecessary investigations.

We describe a case of a 10-year-old immunocompetent girl with a left renal abscess due to Group C Salmonella ( Salmonella serovar Oranienburg). Percutaneous drainage of the abscess was done. She also received 2 weeks of intravenous ceftriaxone, followed by 4 weeks of oral co-trimoxazole with resolution seen on ultrasound. A review of pediatric Salmonella renal abscesses is also presented.

Background Red blood cell distribution width (RDW) is associated with the severe morbidity and mortality of some Gram-negative associated chronic diseases. We designed this retrospective study to identify whether RDW can be used as a factor to provide reference for the treatment of renal abscess. Methods All patients with renal abscess in our institution between April 2016 and November 2019 were collected, and 38 cases with the characteristic of initially diagnosis and no prior treatment were enrolled. Conservative treatment group and surgical intervention group were set based on the treatment of patients. Univariate analysis and the regression analysis were adopted to identify the difference between these two groups. Results Significant differences were found in Diabetes mellitus, RDW and size of renal abscess in both univariate and multifactor analysis. The median value of RDW in all patients was 13.62%, with 13.15% in conservative treatment group and 14.20% receiving surgical intervention (OR: 9.48, 95% CI: 1.15~78.02). Diabetes was present in 42.11% of patients, with the ratio of 20.0% in conservative treatment group and 66.67% in surgical intervention group (OR: 35.22, 95% CI: 1.55~799.05). The cut-off of RDW and size of renal abscess were 14.07% and 3.9 cm respectively. Conclusions RDW as an independent predictor of mortality in patients with Gram-negative bacteremia showed differences among patients with renal abscess who received different treatments. Since the relationship between RDW and Gram-negative bacteremia related to mortality, higher initial RDW value may represent a higher severity of renal abscess and a greater likelihood of the need of surgical intervention.

HDR syndrome is characterized by the triad of primary hypoparathyroidism, sensorineural hearing loss and renal malformation with widely variable manifestations. It is an autosomal dominant inherited disease caused by a mutation of the GATA3 (NM_001002295.2), which is located on chromosome 10p14. Congenital heart disease, such as tetralogy of Fallot, a typical complication of DiGeorge syndrome, is a rare complication of HDR syndrome. We herein report a case of HDR syndrome coexisting tetralogy of Fallot with a novel mutation, c.964C > T (p.Gln322*). This case suggested that the screening of renal involvement should be carefully performed in patients with a phenotypic combination of hypoparathyroidism and sensorineural hearing loss, to facilitate the early diagnosis of HDR syndrome. In addition, when the deletion of chromosome 22q11.2 is not detected by a fluorescence in situ hybridization analysis in patients exhibiting the partial phenotype of DiGeorge syndrome, the possibility of HDR syndrome should be considered and the renal function should be repeatedly evaluated.

Patient: Female, 29-year-old Final Diagnosis: Left duplicated kidney with upper moiety severe hydronephrosis Symptoms: Left side abdominal pain Medication: — Clinical Procedure: Robot-assisted left heminephrectom Specialty: Surgery • Urology Objective: Congenital defects/diseases Background: Duplex kidney, also known as duplex renal collecting system, consists of 2 ureters arising from a single kidney and is a common congenital anomaly. The condition is usually an asymptomatic normal variant. However, abnormal anatomic variants such as hydronephrosis, vesicoureteral reflux (VUR), and ureterocele are sometimes observed in a patient with a duplicated kidney. These abnormal variants usually lead to diagnostic challenges. Here, we report a case of congenital left duplex kidney with hydronephrosis that presented as an isolated left renal cyst in a 29-year-old woman. Case Report: We present the case of a 29-year-old woman who had left-side abdominal pain and fever for 1 day. Left-side flank throbbing pain was also noted. Laboratory investigations showed leukocytosis, pyuria and bacteriuria. Renal ultrasound revealed a huge hypoechoic mass around the left kidney, which was suspected to be a huge renal cyst or renal abscess. Under the impression of acute pyelonephritis with abscess formation, the patient was admitted for antibiotic treatment. The following abdominal computed tomography (CT) revealed a left duplex kidney with severe hydronephrosis and hydroureter. A percutaneous nephrostomy was then performed. Next, following a discussion with the patient, she underwent a robot-assisted left heminephrectomy. Conclusions: A duplex kidney and collecting system should be considered when chronic urologic problems occur. This report shows that because duplex kidney is a relatively common congenital abnormality, it should be considered in the differential diagnosis in young patients who present with renal cyst. This case also shows that patients can be managed effectively using robot-assisted heminephrectomy.

Aim Renal abscesses are relatively uncommon in Paediatrics when compared to the adult population. This may reflect the diagnostic difficulties of such a rare differential in children (in the developed world); its variable clinical presentations, reliance on imaging and non-specific clinical signs. This case series aims to understand the clinical presentation of children with renal abscesses, their possible risk factors, subsequent management and overall outcome. Methods A retrospective chart review of 8 patients (median, 3½ years) from the last 13 years (2005–18) with a diagnosis of renal abscess in terms of their potential unifying risk factors, clinical presentation, ultrasound findings, biochemical parameters, microbiological results, management options (surgical drainage vs. medical management) and overall time to recovery. Results In our cohort, the female to male ratio was 1.6:1. Commonest risk factors were vesicoureteric reflux (25%) and urinary tract infections (25%). The common presenting symptoms were fever (87.5%), flank pain (50%) and generalized abdominal pain (12.5%). Right sided renal abscesses commonly involved the upper pole (75%) while left sided abscesses were both upper (50%) and lower poles (50%). Mean CRP at presentation was 130 (range, 47–283) mg/L with neutrophilic leukocytosis on blood count. Mean creatinine was 49 (range, 20–139) µmol/L; urea 4.2 (range, 1.6–11) mmol/L. Commonest pus culture isolate included E.coli (25%) and S.aureus (25%). Average time to radiological resolution for those managed surgically was 4.3 months and 2.5 months for those managed medically (prolonged course of intravenous antibiotics). Conclusion Clinical presentation of renal abscesses in children is often non-specific. Ultrasound can be used as an initial screening tool. Commonest organisms isolated are S.aureus and E.coli. The time to radiological resolution of abscesses is variable and not improved by surgical intervention. Conservative management should be considered over invasive surgical procedures if the latter can be avoided.