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Friday, December 6, 2013
I am a 30 female, mother of 2, no history of serious health problems, 6 days ago started having RT side pain, abdominal and back. I went to the ER on the 4th day and they thought maybe gall stones but I did have leukocytes in my urine so definately a UTI, although I have no symptoms, Which I had several UTI`s in the past years. Nothing felt like this. They put me on Cipro, Donnatal, and percoset for pain. The following day after 3 doses of everything it seemed worse so I went back to the ER. AFter more labs(normal) another DX of UTI and a CAT scan, they found a abscess on my rt kidney. Gave me Rocephin and Torradal at the ER and mentioned the abscess may or not go away with antiobiotics. They said to follow up with PMD in 72 hours if pain is still present. My question is: I am worried about damage to my kidneys. Of course online research will scare you. The research I have done said it is uncommon and needs drainage before leaving permanent damage. What do you think?
Ahmad Hamidinia, MD:
The diagnosis of renal abscess is a serious one. I believe with this condition you should be in the hospital and be seen by a urologist not the primary care doctor or ER physician. I encourage you to call your Primary care physician to find you a urologist as soon as possible.
This condition is rare and requires strong antibiotics or percutaneous drainage. It is caused by systemic infection spread through your blood. Such conditions are seen in Diabetics or people with compromised immune systems.
Rarely tooth infection and tuberculosis may be the cause.
Do not do more research and see your Urologist as soon as possible.
Mildred Lam, MD:
There are some things in your story that just don't add up. My first thought is that you may not actually have a kidney abscess. People with abscesses are usually quite ill, with fever, chills, severe pain, often nausea and vomiting. They feel terrible and are usually in no condition to do Internet research, because they generally require hospitalization, IV antibiotics, and -- as you point out -- surgical drainage of the abscess. On the other hand, it is difficult to imagine what exactly was seen on your CAT scan that might be mistaken for a renal abscess.
I am also intrigued by your saying that your labs were "normal" on both occasions (except for the white cells in your urine). Did these include a white blood cell count (from your blood, not your urine)? A normal white count would make a serious infection or an abscess less likely. You also do not mention bacteria in the urine, which are generally seen under the microscope and grown on culture when even a simple UTI is present. Be aware that an infection in an organ or structure adjacent to the kidney can indeed result in leukocytes in the urine, even without a UTI being present.
It sounds like the best thing to do at this point is to be seen by your primary doctor immediately. Try to collect all your test results from the ER and bring them with you (including the CAT scan films, or at least the reading, and the results of a urine culture, if one was obtained). Your own doctor should be able to determine how sick you are, whether you need hospitalization and IV antibiotics, and whether you should be seen by a urologist (a surgical kidney doctor) for further treatment of your possible kidney abscess. Prompt treatment of whatever type of infection you have (if you have one) can actually be very effective in preventing permanent damage to the kidney. However, bear in mind that if you do turn out to have a kidney abscess or serious infection, further evaluation may need to be done to determine why this has happened to you, since abscesses often indicate some underlying structural abnormality of the kidney that has allowed such a serious infection to occur.
Ahmad Hamidinia, MD
Formerly, Professor of Clinical Surgery
College of Medicine
University of Cincinnati
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University