目的

探讨儿童肾脓肿的临床特征及治疗方案。

方法

选择2022年1月到2024年12月宁夏医科大学总医院儿科收治的5例肾脓肿患儿（患儿1～5）为研究对象。采用回顾性方法分析法分析其一般资料、临床表现、实验室检查和影像学检查结果，以及治疗结果、门诊随访结果。本研究经宁夏医科大学总医院伦理委员会批准（伦理批号：KYLL-2025-0152），监护人对患儿的诊治均知情同意，并签署临床研究同意书。

结果

①这5例患儿中，男性患儿为3例，女性为2例；年龄为3～13岁；5例患儿临床表现均有反复发热，患儿1、2、4伴腹痛、呕吐及尿路刺激征，仅患儿1有肾区叩击痛体征。②5例患儿治疗前均存在外周血白细胞计数（WBC）、C 反应蛋白（CRP）、红细胞沉降率（ESR）增高，2例尿白细胞增高，1例尿病原菌培养呈阳性，为大肠埃希菌感染所致。③入院后，对5例患儿均进行泌尿系统彩色多普勒超声、肾脏增强CT 或MRI检查。其中，被诊断为左肾脓肿为3例，右肾脓肿为2例，肾上极脓肿为3例，肾下极脓肿为2例，3例患儿的肾脓肿直径＜3 mm，2例直径＞3 mm。3例有肾盂分离。对5例患儿进行泌尿系统彩超检查结果显示，肾实质内可见不均匀低回声团块，边界不清，直径为1.7～5.0 cm。对5例进行肾脏MRI检查结果显示，肾实质可见片状异常信号灶，DWI呈高信号影，边界不清，增强检查可见病变不均匀强化。④对5例患儿均采用保守治疗方案，初始治疗使用哌拉西林钠他唑巴坦钠、美罗培南、厄他培南静脉滴注抗感染，发现疗效不佳后，再采用抗菌作用更强的抗菌药物治疗。⑤出院后，对5例患儿均继续采取口服抗菌药物治疗＞14 d，于出院后2周内复查结果显示肾脓肿均消失，无肾瘢痕形成，停药后门诊随访期间均未出现复发情况。

结论

对儿童肾脓肿患儿采用广谱抗菌药物治疗效果肯定，可作为治疗儿童肾脓肿的首选治疗方案。

Objective

To investigate the clinical characteristics and treatment strategies of renal abscesses in children.

Methods

A total of 5 cases of pediatric renal abscess children（child 1-5）admitted to the Department of Pediatrics，General Hospital of Ningxia Medical University from January 2022 to December 2024 were included into study.A retrospective analysis was conducted on general information，clinical manifestations，laboratory tests，imaging findings，treatment plans，and outpatient follow-up results of these 5 children.This study was approved by the Ethics Committee of the General Hospital of Ningxia Medical University （Ethics Approval No.KYLL-2025-0152），and informed consents were obtained from the guardians of the children for their diagnosis and treatment.

Results

①Among the 5 children，3 cases were male and 2 cases were female，with ages ranging from 3 to 13 years.The clinical manifestations of the 5 children were primarily characterized by recurrent fever，with some children presenting with abdominal pain，vomiting，and urinary tract irritation signs.One child exhibited tenderness on renal percussion，while no other positive physical signs were observed.②Before treatment，all 5 children had elevated peripheral blood white blood cell count（WBC），C-reactive protein （CRP），and erythrocyte sedimentation rate （ESR）.Two children had increased urinary leukocytes，and one child had a positive urine culture，with the pathogen identified as Escherichia coli.③After admission，all 5 children underwent color Doppler ultrasound of the urinary system，enhanced CT of the kidneys，or MRI.Among them，left renal abscess was found in 3 children，and right renal abscess in 2 children.Upper pole abscess was present in 3 children，and lower pole abscess in 2 children.Three children had renal abscess diameters less than 3 mm，while 2 children had diameters greater than 3 mm.Three children exhibited hydronephrosis.Color Doppler ultrasound of the urinary system showed hypoechoic masses within the renal parenchyma with unclear borders，with diameters ranging from 1.7 to 5.0 cm.MRI of the kidneys revealed patchy abnormal signals within the renal parenchyma，with high signal intensity on diffusion-weighted imaging（DWI）and unclear borders；enhanced scanning showed heterogeneous enhancement of the lesions.④All children received conservative treatment.Initial treatment involved intravenous infusion of broadspectrum antibiotics （piperacillin-tazobactam，meropenem，or ertapenem）for anti-infection therapy.However，the therapeutic effect was unsatisfactory，leading to an upgrade in antibiotic treatment.⑤After discharge，all children continued oral antibiotic therapy for more than 14 days.Follow-up within 2 weeks after discharge showed complete resolution of renal abscesses without renal scar formation.No recurrence was observed during the outpatient follow-up period after discontinuation of medication.

Conclusions

The use of broad-spectrum antibiotics for the treatment of pediatric renal abscesses has proven to be effective and can be recommended as the first-line therapeutic approach.