G339(P) A case series on the presentation and management of paediatric renal abscesses

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.