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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.

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Photomicrography of the kidney. A – Chronic pyelonephritis with necrotizing papillitis (arrow) and, above this area, subcapsular coagulative necrosis (arrowhead) (H&E, 40X). B – Renal cortex with arterial fibroelastosis, indicated by a circle, at the bottom of a shallow area of coagulative necrosis (arrows) (H&E, 200X). C – Chronic pyelonephritis with abscesses (H&E, 400X). D – Necrotizing papillitis (H&E, 400X).
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g04: Photomicrography of the kidney. A – Chronic pyelonephritis with necrotizing papillitis (arrow) and, above this area, subcapsular coagulative necrosis (arrowhead) (H&E, 40X). B – Renal cortex with arterial fibroelastosis, indicated by a circle, at the bottom of a shallow area of coagulative necrosis (arrows) (H&E, 200X). C – Chronic pyelonephritis with abscesses (H&E, 400X). D – Necrotizing papillitis (H&E, 400X).

Mentions: The histopathological study of the transplanted kidney was consistent with chronic suppurative pyelonephritis with necrotizing papillitis. Histopathological findings showed an extensive acute inflammatory process with multiple abscesses in the cortical. Small areas of superficial ischemic necrosis were also seen. The medulla showed papillary necrosis characterized by ischemic necrosis surrounded by intensive suppurative inflammatory infiltration and calcium deposits. Newly formed vessels and fibrosis were observed in the renal parenchyma (Figure 4A, 4B, 4C, and 4D).


Emphysematous pyelonephritis in a transplanted kidney
Photomicrography of the kidney. A – Chronic pyelonephritis with necrotizing papillitis (arrow) and, above this area, subcapsular coagulative necrosis (arrowhead) (H&E, 40X). B – Renal cortex with arterial fibroelastosis, indicated by a circle, at the bottom of a shallow area of coagulative necrosis (arrows) (H&E, 200X). C – Chronic pyelonephritis with abscesses (H&E, 400X). D – Necrotizing papillitis (H&E, 400X).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

g04: Photomicrography of the kidney. A – Chronic pyelonephritis with necrotizing papillitis (arrow) and, above this area, subcapsular coagulative necrosis (arrowhead) (H&E, 40X). B – Renal cortex with arterial fibroelastosis, indicated by a circle, at the bottom of a shallow area of coagulative necrosis (arrows) (H&E, 200X). C – Chronic pyelonephritis with abscesses (H&E, 400X). D – Necrotizing papillitis (H&E, 400X).
Mentions: The histopathological study of the transplanted kidney was consistent with chronic suppurative pyelonephritis with necrotizing papillitis. Histopathological findings showed an extensive acute inflammatory process with multiple abscesses in the cortical. Small areas of superficial ischemic necrosis were also seen. The medulla showed papillary necrosis characterized by ischemic necrosis surrounded by intensive suppurative inflammatory infiltration and calcium deposits. Newly formed vessels and fibrosis were observed in the renal parenchyma (Figure 4A, 4B, 4C, and 4D).

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