Primary Subcapsular Reflux as an Etiology of Subcapsular Renal Abscess

Herein, we report two rare cases of renal infection. The first case was renal subcapsular urine reflux in a 8-month-old girl with recurrent urinary tract infection and the second was subcapsular abscess in a 14-year-old girl with diabetes, who was successfully treated with percutaneous drainage. It has been suggested that renal subcapsular abscesses could be caused by the direct reflux of urine into the subcapsular space, rather than spread of infection from an existing parenchymal lesion, and that complete recovery can be achieved if percutaneous drainage is performed in a timely manner. We propose primary subcapsular reflux, in which urine directly refluxes upwards into the subcapsular space of the kidney, as one of the mechanisms for development of renal subcapsular abscesses.

Acute lobar nephronia: Pitfalls and insights of an underdiagnosed urologic condition

Background: Acute lobar nephronia (ALN) is an underdiagnosed urological condition which has scarce publications available. It is described as an acute inflammatory and bacterial infection of the kidney without liquefaction, and in fact likely represents a mid-point between acute pyelonephritis and renal abscess. Patients usually present with fevers, septic shock, and occasionally abdominal and flank pain. To date there is no consensus on its optimal management. Objective: The aim of this study was to describe the presentation, evaluation, multidisciplinary involvement and management, and follow-up of ALN. Method: An observational study was performed utilising four patients from our single centre urology department. Data collected included basic demographics and diagnosis and management. All four patients are presented below. Observations and comparisons were made between all patients to aid in understanding the commonality between their presentations and managements. Conclusion: ALN is an underdiagnosed condition. Its diagnosis and management is difficult and requires a multidisciplinary approach. Many patients require prolonged inpatient management and close follow-up. An underlying renal mass is always an important differential diagnosis to be considered. Level of evidence: Not applicable for this multicentre audit.