Kidney abscess in pediatrics: 2 case reports

Abstract

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.