1
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Bacha MM, Mami I, Gaied H, Ounissi M, Hedri H, Abderrahim E, Ben Abdallah T. [Emphysematous pyelonephritis and cystitis: An exceptional complication in a kidney transplant recipient]. Nephrol Ther 2021; 17:458-462. [PMID: 33994137 DOI: 10.1016/j.nephro.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 01/28/2021] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Abstract
Emphysematous pyelonephritis is a rare and severe infectious complication characterized by the presence of gas in the renal parenchyma, excretory cavities and surrounded tissues. It is due to the development of non-anaerobic gasifier bacteria. We report a new rare case of emphysematous pyelonephritis in a kidney transplant recipient, particular by its occurrence in a non-functional graft and its exceptional association with emphysematous cystitis.
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Affiliation(s)
- Mohamed Mongi Bacha
- Service de médecine interne A, hôpital Charles-Nicolle, boulevard du 9 Avril, 1006 BS Tunis, Tunisie; Laboratoire de recherche d'immunologie de la transplantation rénale et d'immunopathologie (LR03SP01), hôpital Charles-Nicolle, boulevard du 9 Avril, 1006 BS Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie.
| | - Ikram Mami
- Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie; Service de néphrologie, hôpital La Rabta, 1007 Jabbari, Tunis, Tunisie
| | - Hanène Gaied
- Service de médecine interne A, hôpital Charles-Nicolle, boulevard du 9 Avril, 1006 BS Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - Mondher Ounissi
- Service de médecine interne A, hôpital Charles-Nicolle, boulevard du 9 Avril, 1006 BS Tunis, Tunisie; Laboratoire de recherche d'immunologie de la transplantation rénale et d'immunopathologie (LR03SP01), hôpital Charles-Nicolle, boulevard du 9 Avril, 1006 BS Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - Hafedh Hedri
- Service de médecine interne A, hôpital Charles-Nicolle, boulevard du 9 Avril, 1006 BS Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - Ezzeddine Abderrahim
- Service de médecine interne A, hôpital Charles-Nicolle, boulevard du 9 Avril, 1006 BS Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - Taïeb Ben Abdallah
- Service de médecine interne A, hôpital Charles-Nicolle, boulevard du 9 Avril, 1006 BS Tunis, Tunisie; Laboratoire de recherche d'immunologie de la transplantation rénale et d'immunopathologie (LR03SP01), hôpital Charles-Nicolle, boulevard du 9 Avril, 1006 BS Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
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2
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Takahashi K, Malinzak LE, Safwan M, Kim DY, Patel AK, Denny JE. Emphysematous pyelonephritis in renal allograft related to antibody-mediated rejection: A case report and literature review. Transpl Infect Dis 2018; 21:e13026. [PMID: 30414224 DOI: 10.1111/tid.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/01/2018] [Accepted: 10/28/2018] [Indexed: 11/27/2022]
Abstract
Emphysematous pyelonephritis (EPN) is a rare condition which can rapidly progress to sepsis and multiple organ failure with high mortality. We experienced a rare case of EPN in a renal allograft related to antibody-mediated rejection (AMR). The patient received a deceased donor kidney transplant due to end-stage renal disease secondary to diabetes mellitus. Cross-match test was negative but she had remote history of anti-HLA-A2 antibody corresponding with the donor HLA. Surgery concluded without any major events. Anti-thymoglobulin was given perioperatively for induction. She was compliant with her immunosuppressive medications making urine of 2 L/d with serum creatinine of 1.9 mg/dL at discharge on post-operative day (POD) 6. She did well until POD 14 when she presented to the clinic with features of sepsis, pain over the transplanted kidney area and decline in urine volume with elevated serum creatinine. CT revealed extensive gas throughout the transplanted kidney. Renal scan revealed non-functional transplant kidney with no arterial flow. Based on these findings, a decision to perform transplant nephrectomy was made. At laparotomy, the kidney was completely necrotic. Pathology showed non-viable kidney parenchyma with the tubules lacking neutrophilic casts suggestive of ischemic necrosis. Donor-specific antibody (DSA) returned positive with high intensity anti-HLA-A2 antibody. This is the first case of early EPN in allograft considered to have occurred as a result of thrombotic ischemia secondary to AMR. This case suggests consideration of perioperative anti-B-cell and/or anti-plasma cell therapies for historical DSA and strict post-operative follow-up in immunologically high-risk recipients to detect early signs of rejection and avoid deleterious outcomes.
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Affiliation(s)
- Kazuhiro Takahashi
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Lauren E Malinzak
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Mohamed Safwan
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Dean Y Kim
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Anita K Patel
- Department of Nephrology and Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Jason E Denny
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
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3
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Saadi A, Ayed H, Karray O, Kerkeni W, Bouzouita A, Cherif M, Ben Slama R, Derouiche A, Chebil M. [Rare complication of renal transplantation: Emphysematous pyelonephritis]. Nephrol Ther 2017; 13:479-481. [PMID: 28760516 DOI: 10.1016/j.nephro.2017.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/28/2022]
Abstract
Emphysematous pyelonephritis is a necrotizing infection of the renal parenchyma and peri-renal tissues, characterized by the presence of air within the parenchyma of the urinary tract and peri-renal space. This is a severe complication, which involves the functional prognosis of the kidney and the patient's prognosis. The emphysematous pyelonephritis is a rare complication of renal transplantation. Its gravity is linked particularly to the fragility of immunosuppressed patients. The authors report the case of an emphysematous pyelonephritis having occurred 9 months after transplantation in a patient 58 years. The evolving risks and therapeutic modalities will be outlined and discussed.
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Affiliation(s)
- Ahmed Saadi
- Urology department, Charles-Nicolle hospital, university of Tunis El Manar, boulevard 9-Avril-1938, 1006 Tunis, Tunisie.
| | - Haroun Ayed
- Urology department, Charles-Nicolle hospital, university of Tunis El Manar, boulevard 9-Avril-1938, 1006 Tunis, Tunisie
| | - Omar Karray
- Urology department, Charles-Nicolle hospital, university of Tunis El Manar, boulevard 9-Avril-1938, 1006 Tunis, Tunisie
| | - Walid Kerkeni
- Urology department, Charles-Nicolle hospital, university of Tunis El Manar, boulevard 9-Avril-1938, 1006 Tunis, Tunisie
| | - Abderrazak Bouzouita
- Urology department, Charles-Nicolle hospital, university of Tunis El Manar, boulevard 9-Avril-1938, 1006 Tunis, Tunisie
| | - Mohamed Cherif
- Urology department, Charles-Nicolle hospital, university of Tunis El Manar, boulevard 9-Avril-1938, 1006 Tunis, Tunisie
| | - Riadh Ben Slama
- Urology department, Charles-Nicolle hospital, university of Tunis El Manar, boulevard 9-Avril-1938, 1006 Tunis, Tunisie
| | - Amine Derouiche
- Urology department, Charles-Nicolle hospital, university of Tunis El Manar, boulevard 9-Avril-1938, 1006 Tunis, Tunisie
| | - Mohamed Chebil
- Urology department, Charles-Nicolle hospital, university of Tunis El Manar, boulevard 9-Avril-1938, 1006 Tunis, Tunisie
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4
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Narcisse D, Agarwal M, Hancock M, Wells D, Sands C. A rare case of emphysematous pyelonephritis in a renal transplant patient. Ther Adv Infect Dis 2016; 3:141-144. [PMID: 28386406 DOI: 10.1177/2049936116678122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is a rare life-threatening complication of a properly functioning renal allograft leading to potential graft loss and hemodialysis. Currently, no clear management guidelines exist in these clinically challenging immunosuppressed renal transplant recipients. We report a case of a 62-year-old woman who presented with class 4 EPN and was managed with intravenous antibiotics and nephrectomy at our medical center.
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Affiliation(s)
- Dennis Narcisse
- Department of Internal-Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Manyoo Agarwal
- Department of Internal Medicine, The University of Tennessee Health Science Center, 956 Court Avenue Suite H314, Memphis, TN 38103, USA
| | - Michael Hancock
- Department of Internal-Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Daniel Wells
- Department of Internal-Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Christopher Sands
- Department of Internal-Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
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5
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Emphysematous pyelonephritis in a renal transplant recipient. A case report. Nefrologia 2015; 36:184-6. [PMID: 26306947 DOI: 10.1016/j.nefro.2015.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/07/2015] [Accepted: 05/15/2015] [Indexed: 11/22/2022] Open
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6
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Ágreda Castañeda F, Lorente D, Trilla Herrera E, Gasanz Serrano C, Servian Vives P, Iztueta Saavedra I, Morote Robles J. Extensive emphysematous pyelonephritis in a renal allograft: case report and review of literature. Transpl Infect Dis 2014; 16:642-7. [DOI: 10.1111/tid.12246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/03/2014] [Accepted: 03/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - D. Lorente
- Department of Urology; Vall d′Hebrón Hospital, Barcelona; Barcelona Spain
| | - E. Trilla Herrera
- Department of Urology; Vall d′Hebrón Hospital, Barcelona; Barcelona Spain
| | - C. Gasanz Serrano
- Department of Urology; Vall d′Hebrón Hospital, Barcelona; Barcelona Spain
| | - P. Servian Vives
- Department of Urology; Vall d′Hebrón Hospital, Barcelona; Barcelona Spain
| | | | - J. Morote Robles
- Department of Urology; Vall d′Hebrón Hospital, Barcelona; Barcelona Spain
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7
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Winnicki E, Nguyen S, Butani L. Gross hematuria as a sign of acute rejection. Pediatr Transplant 2014; 18:E106-8. [PMID: 24802349 DOI: 10.1111/petr.12258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Abstract
In the contemporary era of potent immunosuppressive regimens, previously encountered signs of renal allograft rejection such as fever and hematuria are rarely encountered. We report a teenager with severe recurrent acute humoral and cellular rejection whose presenting feature was gross hematuria with the presence of blood clots in the urine. We want to highlight that severe rejection even in the setting of modern immunosuppressive drugs can present as gross hematuria. Contrary to conventional wisdom that gross hematuria with the presence of blood clots in the urine is indicative of pathology in the renal collecting system, a parenchymal disease process should also be considered in renal transplant recipients.
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Affiliation(s)
- Erica Winnicki
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, USA
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8
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Tienza A, Hevia M, Merino I, Velis JM, Algarra R, Pascual JI, Zudaire JJ, Robles JE. Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment. Can Urol Assoc J 2014; 8:E256-9. [PMID: 24839494 DOI: 10.5489/cuaj.1555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney and perinephric space that carries a bad prognosis. Apart from its predisposing clinical entities, diabetes mellitus and immune-incompetence are quite common in patients with this infection. We report a case of a 53-year-old kidney transplant recipient diabetic male, suffering from recurrent fever, abdominal pain and nausea episodes. Immediate broad-spectrum antibiotics were administered and percutaneous drainage was performed after the diagnosis. The bacteria involved were Stahpylococcus epidermidis and Escherichia coli. After 4 weeks of antibiotic treatment and abscesses drainage, the case was resolved. Consecutives urine cultures and ultrasonographies confirm the complete resolution of the disease. We discuss the predisposing factors, clinical presentation and management.
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Affiliation(s)
| | - Mateo Hevia
- Clínica Universidad de Navarra, Pamplona, Spain
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9
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Alexander S, Varughese S, David V, Kodgire S, Mukha R, Kekre N, Tamilarasi V, Jacob C, John G. Extensive emphysematous pyelonephritis in a renal allograft treated conservatively: case report and review of the literature. Transpl Infect Dis 2012; 14:E150-5. [DOI: 10.1111/tid.12016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 06/09/2012] [Accepted: 06/20/2012] [Indexed: 11/29/2022]
Affiliation(s)
- S. Alexander
- Department of Nephrology; Christian Medical College; Vellore; India
| | - S. Varughese
- Department of Nephrology; Christian Medical College; Vellore; India
| | - V.G. David
- Department of Nephrology; Christian Medical College; Vellore; India
| | - S.V. Kodgire
- Department of Nephrology; Christian Medical College; Vellore; India
| | - R.P. Mukha
- Department of Urology; Christian Medical College; Velore; India
| | - N.S. Kekre
- Department of Urology; Christian Medical College; Velore; India
| | - V. Tamilarasi
- Department of Nephrology; Christian Medical College; Vellore; India
| | - C.K. Jacob
- Department of Nephrology; Christian Medical College; Vellore; India
| | - G.T. John
- Department of Renal Medicine; Royal Brisbane and Women's Hospital; Queensland; Australia
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10
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Abstract
Urinary tract infections are common following renal transplant. The spectrum varies from asymptomatic bacteriuria to septicemia. Gas-producing infections of the urinary tract are rare but tend to have a grave prognosis when they do occur. We report a 57-year-old gentleman who underwent a renal transplant 20 months earlier. He presented to us with fever and dysuria. Clinical examination revealed a febrile and ill-looking patient with severe graft tenderness. An emergency pelvic CT scan revealed presence of emphysematous prostatitis, cystitis and pyelitis. Urine and blood cultures grew E. coli. Endoscopic abscess drainage was done and antibiotics given but he succumbed to his illness due to multiorgan failure within 48h. This is the first reported case of emphysematous prostatitis in a renal allograft recipient.
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Affiliation(s)
- Krishnaswamy Sampathkumar
- Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai - 625 107, India
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11
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Lang EK, Rudman E, Zhang K, Thorner D, Hanano A. Myceleal emphysematous cystitis complicating a renal transplant kidney. Int Braz J Urol 2011; 37:268-9. [PMID: 21557844 DOI: 10.1590/s1677-55382011000200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Erich K Lang
- Department Radiology and Urology, SUNY Downstate Medical School, Brooklyn, New York, NY 11203, USA.
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12
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Chouaib A, Sebe P, Haab F, Tligui M. [Emphysematous pyelonephritis in a kidney allograft: indication for a secondary nephrectomy]. Med Mal Infect 2011; 41:443-5. [PMID: 21514754 DOI: 10.1016/j.medmal.2011.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 02/23/2011] [Accepted: 03/16/2011] [Indexed: 11/26/2022]
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13
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Al-Geizawi SMT, Farney AC, Rogers J, Assimos D, Requarth JA, Doares W, Winfrey S, Stratta RJ. Renal allograft failure due to emphysematous pyelonephritis: successful non-operative management and proposed new classification scheme based on literature review. Transpl Infect Dis 2010; 12:543-50. [PMID: 20825591 DOI: 10.1111/j.1399-3062.2010.00538.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Emphysematous pyelonephritis (EPN) is a rare necrotizing infection of the kidney caused by gas-forming organisms, usually occurs in diabetic patients, and often requires nephrectomy for effective therapy. EPN is rarely reported in renal allografts, with only 20 cases found in the English literature. We report herein a case of EPN in a transplanted kidney resulting in acute renal failure and sepsis. The patient was managed non-operatively with subsequent recovery of renal allograft function. Based on this experience and a review of the literature, we suggest an amended classification system for EPN in kidney transplantation to plan and guide treatment options accordingly. However, the scarcity of this disease process, coupled with the lack of prospective validation of the new classification scheme, prevents drawing definitive conclusions regarding optimal management strategies including the role and timing of allograft nephrectomy.
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Affiliation(s)
- S M T Al-Geizawi
- Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA
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14
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Abstract
Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal parenchymal infection that is characterized by the production of intraparenchymal gas. EPN predominantly affects female diabetics, and can occur in insulin-dependent and non-insulin-dependent patients in the absence of ureteric obstruction. Nondiabetic patients can also develop EPN, but often have ureteric obstruction and do not seem to develop such extensive disease. One gaseous component-carbon dioxide-is generated by bacterial fermentation of glucose (present in excess in diabetics) and acids. Patients with EPN show relatively vague symptoms initially, but frequently undergo a sudden deterioration in their condition, necessitating urgent medical attention. Treatment of patients with EPN comprises resuscitation, correction of any electrolyte and glucose problems, and administration of antibiotics targeting Gram-negative bacteria. Ureteric obstruction, if present, is relieved by a percutaneous nephrostomy or stent. Definitive management is by percutaneous drainage, except when there is extensive diffuse gas with renal destruction; in this case, a nephrectomy is advised. The requirement for a nephrectomy could potentially be avoided by early diagnosis and treatment of diabetics with urinary infection. With the advent of CT, a staging system of the gas patterns generated in the kidneys of EPN patients has evolved. Risk factors have been defined to aid management.
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15
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Mohsin N, Budruddin M, Lala S, Al-Taie S. Emphysematous pyelonephritis: a case report series of four patients with review of literature. Ren Fail 2010; 31:597-601. [PMID: 19839858 DOI: 10.1080/08860220903003396] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is an acute necrotizing infection with gas presence in the kidney, perinephric space, and/or urinary collecting system that carries a bad prognosis. Some clinical conditions predispose to this entity, such as diabetes mellitus, urinary tract obstruction, and immune-incompetence. Immediate resuscitation, broad-spectrum antibiotics, percutaneous and surgical drainage, and emergent and delayed nephrectomy are therapeutic options that should be applied in a timely fashion. We report our experience of four patients with EPN. Two of the patients were kidney transplant recipients, one patient had bilateral urolithiasis, and one patient was an elderly patient with debilitated general condition and an abdominal mass that could not be defined. Late transplant nephrectomy was performed in one patient, and three patients were treated conservatively. Three patients died, including the patient who had transplant nephrectomy. One patient who presented with lithiasis showed a remarkable recovery with conservative management. The bacteria involved were E. Coli and a resistant Klebsiella. We conclude that EPN is a life-threatening condition that carries a bad prognosis. Early diagnosis is essential for a positive outcome. Therapeutic measures should be applied immediately after diagnosis. An aggressive approach including nephrectomy may be emergently required.
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Affiliation(s)
- N Mohsin
- Department of Nephrology, Royal Hospital, Muscat, Oman.
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16
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Khaira A, Gupta A, Rana DS, Gupta A, Bhalla A, Khullar D. Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis. Int Urol Nephrol 2009; 41:959-66. [PMID: 19404766 DOI: 10.1007/s11255-009-9552-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 02/27/2009] [Indexed: 10/20/2022]
Abstract
AIM We aimed to study the clinical profile, prognostic factors, and the 6-month outcome of patients with emphysematous pyelonephritis (EPN) METHODS: All patients admitted with a diagnosis of emphysematous pyelonephritis between January 2001 and July 2007 were included. RESULTS Overall 19 cases were diagnosed to have emphysematous pyelonephritis. There were 16 females and three males. Fourteen cases had type 2 diabetes mellitus. Fourteen cases had unilateral involvement and five had bilateral involvement. Eleven cases were classified as having class 1 or 2 disease and eight cases had class 3 and 4 disease. E. coli was the most common organism cultured (68.4%). Five cases underwent percutaneous drainage of the collecting system and three cases had nephrectomy of which 10.5% (two with advanced disease) expired. Shock at admission (p = 0.03), serum creatinine >5.0 mg/dl (p = 0.035) and DIC (p = 0.017) were independent poor prognostic factors. There was no difference in the prognosis between patients who had >or=2 or <2 poor prognostic factors (p = 0.16). However, prognosis was not related to disease class, unilateral vs. bilateral involvement, sepsis or the age of the patient. At 6 months, two patients were on maintenance hemodialysis. CONCLUSIONS In cases of EPN, shock, serum creatinine >5.0 mg/dl and DIC at admission are poor prognostic factors. Larger prospective studies are needed to confirm our findings.
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Affiliation(s)
- Ambar Khaira
- Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, 110029, India.
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17
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Schmidt S, Foert E, Zidek W, van der Giet M, Westhoff TH. Emphysematous pyelonephritis in a kidney allograft. Am J Kidney Dis 2009; 53:895-7. [PMID: 19344987 DOI: 10.1053/j.ajkd.2008.12.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 12/31/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Sven Schmidt
- Department of Nephrology, Charité-Campus Benjamin Franklin, Berlin, Germany
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18
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Debnath J, Baliga KV, George RA, Satija L, Khanduja R, Vaidya A, Sandhu AS, Hanagandi PB, Sawant MB. Temporal evolution of emphysematous pyelonephritis in a renal allograft: imaging findings. Emerg Radiol 2008; 16:231-3. [DOI: 10.1007/s10140-008-0728-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 03/28/2008] [Indexed: 10/22/2022]
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19
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Salmonella Emphysematous Pyelonephritis in a Nondiabetic and Non-Obstructive End-Stage Renal Disease Patient. Tzu Chi Med J 2007. [DOI: 10.1016/s1016-3190(10)60024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Ortiz A, Petkov V, Urbano J, Contreras J, Alexandru S, Garcia-Pérez A, Ramos A, Cabrera JM, Albalate M, Garcia-Cardoso JV. Emphysematous pyelonephritis in dialysis patient after embolization of failed allograft. Urology 2007; 70:372.e17-9. [PMID: 17826516 DOI: 10.1016/j.urology.2007.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 03/13/2007] [Accepted: 04/30/2007] [Indexed: 11/19/2022]
Abstract
Emphysematous pyelonephritis is an uncommon acute infection characterized by the presence of gas in the renal parenchyma. Diabetics account for most cases, and the mortality rate is high. We report a case of emphysematous pyelonephritis after therapeutic embolization of a nonfunctioning renal graft in a nondiabetic dialysis patient. Given the increasing popularity of therapeutic embolization to control graft intolerance syndrome associated with rejected kidneys, physicians should be aware of this potentially severe complication. We discuss the differential diagnosis from entities requiring different management strategies, such as postembolization syndrome, persistence of graft intolerance, and the presence of sterile intrarenal.
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Affiliation(s)
- Alberto Ortiz
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain.
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21
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Hervé F, Lahaxe L, Robaday S, Lévesque H, Marie I. Une volumineuse pseudotumeur rénale. Rev Med Interne 2006; 27:878-80. [PMID: 16678935 DOI: 10.1016/j.revmed.2006.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 02/27/2006] [Indexed: 11/23/2022]
Affiliation(s)
- F Hervé
- Département de médecine interne, CHU Rouen-Boisguillaume, 76031 Rouen cedex, France
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Arai S, Makino T, Okugi H, Hasumi M, Shibata Y, Hatori M, Suzuki K. A case of emphysematous pyelonephritis in a renal allograft. Transplantation 2006; 81:296-7. [PMID: 16436977 DOI: 10.1097/01.tp.0000191623.83885.ee] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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