History
Common signs and symptoms in patients with renal corticomedullary abscess include fever, chills, nausea/vomiting, and flank or abdominal pain. Some individuals with renal corticomedullary abscess develop dysuria and other urinary tract symptoms.
Nonspecific constitutional symptoms (eg, malaise, fatigue, weight loss) may occur in patients with xanthogranulomatous pyelonephritis (XGP). Besides abscess formation, other rare complications have included reno-cutaneous fistula, reno-colonic fistula, and reno-bronchial fistula. [7]
Obtaining a thorough medical history is important in evaluating patients with a possible renal corticomedullary abscess. Patients with this infection frequently have long-standing (approximately 14 d) symptoms such as fever, back pain, and/or abdominal discomfort. Unfortunately, these symptoms may be vague and do not always reflect the severity of the infection. In addition, various host factors influence the development and severity of renal infection (see Overview/Etiology). Most patients with renal corticomedullary abscess have a history of recurrent urinary tract infections, renal calculi, and/or prior genitourinary tract instrumentation. Urinary tract obstruction is an important predisposing factor.
Physical Examination
Signs that accompany renal corticomedullary abscess vary greatly and are nonspecific. However, the physical examination findings usually indicate significant infection, including ill appearance, fever, and hemodynamic instability. In patients with accompanying sepsis, the hemodynamic and overall instability may be more pronounced, with tachycardia, hypotension, and tachypnea. In addition, some patients with renal corticomedullary abscess have palpable masses. Costovertebral angle tenderness is almost uniformly present with each type of corticomedullary infection.
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Contrasted CT scan that demonstrates a corticomedullary abscess in a 27-year-old patient with diabetes mellitus who has a history of multiple urinary tract infections. Note the heterogeneous hypodense lesion in the right kidney. Extracapsular extension is not present.
