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Emphysematous pyelonephritis in a transplanted kidney

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ABSTRACT

Emphysematous pyelonephritis is a rare infection characterized by necrosis and gas accumulation in the renal parenchyma, adjacent tissues, and/or urinary collecting system. This entity is rarely reported in transplanted kidneys. Computed tomography imaging is necessary for diagnosis and risk classification. The authors described the case of a 58-year-old man who underwent a kidney transplant and presented sepsis from a urinary tract infection. An abdominal tomography showed some characteristics of emphysematous pyelonephritis associated with an abscess. A graft biopsy, performed 45 days after the transplant, failed to show signs of infection, and tubule-interstitial and vascular rejection were ruled out. The patient had a poor outcome, and a nephrectomy was needed, the pathological analysis of which yielded the diagnosis of chronic pyelonephritis with necrotizing papillitis. The patient became hemodynamically unstable and died. The authors highlight the current tomographic criteria for the diagnosis and treatment of emphysematous pyelonephritis and question the validity of accepting the same standards used to guide the treatment of patients without transplants, and call attention to the importance of the clinical status for the indication of nephrectomy in cases of emphysematous pyelonephritis.

No MeSH data available.


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Abdominal CT images. A – Axial image: the graft surrounded by inflammatory process and gas (arrow) in contact with an abscess (A); perigraft abscess in close contact with the psoas muscle (arrowhead); B – Coronal plane. Note the abscess juxtaposed to the psoas muscle.
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g02: Abdominal CT images. A – Axial image: the graft surrounded by inflammatory process and gas (arrow) in contact with an abscess (A); perigraft abscess in close contact with the psoas muscle (arrowhead); B – Coronal plane. Note the abscess juxtaposed to the psoas muscle.

Mentions: Two days after the biopsy, the patient returned to the emergency facility presenting severe sepsis due to urinary infection (ESBL+Klebsiella sp. was isolated from the urine and blood cultures) and was started on antibiotic therapy with imipenem. Over the following days, the patient progressed with worsening clinical status, presenting hypotension, tachycardia, and shock. The abdominal CT showed a homogeneous fluid collection, measuring 9.4 × 7.0 cm, in the upper pole of the graft, with contiguity with the psoas muscle and a gaseous component in the pelvis and chalices of the graft extending to subcutaneous tissue. These findings were consistent with EP and perigraft collection (Figure 2A and 2B).


Emphysematous pyelonephritis in a transplanted kidney
Abdominal CT images. A – Axial image: the graft surrounded by inflammatory process and gas (arrow) in contact with an abscess (A); perigraft abscess in close contact with the psoas muscle (arrowhead); B – Coronal plane. Note the abscess juxtaposed to the psoas muscle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304561&req=5

g02: Abdominal CT images. A – Axial image: the graft surrounded by inflammatory process and gas (arrow) in contact with an abscess (A); perigraft abscess in close contact with the psoas muscle (arrowhead); B – Coronal plane. Note the abscess juxtaposed to the psoas muscle.
Mentions: Two days after the biopsy, the patient returned to the emergency facility presenting severe sepsis due to urinary infection (ESBL+Klebsiella sp. was isolated from the urine and blood cultures) and was started on antibiotic therapy with imipenem. Over the following days, the patient progressed with worsening clinical status, presenting hypotension, tachycardia, and shock. The abdominal CT showed a homogeneous fluid collection, measuring 9.4 × 7.0 cm, in the upper pole of the graft, with contiguity with the psoas muscle and a gaseous component in the pelvis and chalices of the graft extending to subcutaneous tissue. These findings were consistent with EP and perigraft collection (Figure 2A and 2B).

View Article: PubMed Central - PubMed

ABSTRACT

Emphysematous pyelonephritis is a rare infection characterized by necrosis and gas accumulation in the renal parenchyma, adjacent tissues, and/or urinary collecting system. This entity is rarely reported in transplanted kidneys. Computed tomography imaging is necessary for diagnosis and risk classification. The authors described the case of a 58-year-old man who underwent a kidney transplant and presented sepsis from a urinary tract infection. An abdominal tomography showed some characteristics of emphysematous pyelonephritis associated with an abscess. A graft biopsy, performed 45 days after the transplant, failed to show signs of infection, and tubule-interstitial and vascular rejection were ruled out. The patient had a poor outcome, and a nephrectomy was needed, the pathological analysis of which yielded the diagnosis of chronic pyelonephritis with necrotizing papillitis. The patient became hemodynamically unstable and died. The authors highlight the current tomographic criteria for the diagnosis and treatment of emphysematous pyelonephritis and question the validity of accepting the same standards used to guide the treatment of patients without transplants, and call attention to the importance of the clinical status for the indication of nephrectomy in cases of emphysematous pyelonephritis.

No MeSH data available.


Related in: MedlinePlus