From the Guidelines
The management of perinephric stranding should primarily focus on treating the underlying cause, with a tailored approach based on the specific etiology, and may include medical therapy, percutaneous drainage, or surgery for refractory cases, as indicated by the most recent guidelines 1. The treatment typically begins with addressing any infection through appropriate antibiotics, and given the potential for gram-negative bacteria or hematogenous seeding from organisms like Staphylococcus aureus, broad-spectrum antibiotics may be considered initially.
- Key considerations in management include:
- The use of CT imaging for diagnosis and management, as it is crucial for guiding treatment decisions.
- The decision to opt for drainage of any associated abscess, which is often influenced by the size of the abscess.
- The potential need for surgical intervention in refractory cases or those with significant complications. Pain management and adequate hydration are also important components of the treatment plan, with recommendations for pain control using acetaminophen or NSAIDs like ibuprofen, and a daily fluid intake of 2-3 liters to help flush the urinary system.
- Regular follow-up imaging is necessary to ensure resolution of the stranding and to monitor for any complications, with the treatment approach tailored to the specific underlying cause, as perinephric stranding is a radiological finding that indicates inflammation rather than a specific diagnosis, as noted in the guidelines for the prevention, diagnosis, and management of urinary tract infections 1.
From the Research
Perinephric Stranding Management and Treatment
- The management and treatment of perinephric stranding depend on the underlying cause, which can include infections, obstructions, or other conditions 2, 3.
- In cases of perinephric abscess, treatment typically involves drainage of the abscess, either percutaneously or surgically, in combination with appropriate antibiotic coverage 2, 3.
- Antibiotic therapy should be initiated promptly to prevent serious complications, and the choice of antibiotic should take into account the risk of resistance 4.
- For patients with perinephric stranding due to other causes, such as obstructive ureteral stones, treatment may involve relieving the obstruction and managing any associated complications, such as hemorrhagic shock 5.
- In some cases, perinephric stranding may be a sign of a more serious underlying condition, such as non-Hodgkin lymphoma, and further evaluation and treatment may be necessary 6.
Diagnostic Considerations
- Perinephric stranding can be diagnosed using imaging studies, such as computed tomography (CT) scans, which can help identify the underlying cause of the stranding 2, 3.
- Laboratory tests, such as blood and urine cultures, may also be helpful in diagnosing the underlying cause of perinephric stranding 2, 3.
- A high index of suspicion is necessary to diagnose perinephric stranding, as the clinical presentation can be nonspecific and may resemble other conditions 2.
Treatment Outcomes
- The outcome of treatment for perinephric stranding depends on the underlying cause and the promptness and effectiveness of treatment 2, 3.
- In general, early recognition and treatment of perinephric stranding can help reduce morbidity and mortality 2, 3.
- However, in some cases, perinephric stranding can be a sign of a life-threatening condition, and delayed or inadequate treatment can lead to serious complications or death 5.