Emphysematous pyelonephritis in a transplanted kidney

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.

Pielonefrite contagiosa bovina em vaca holandesa: relato de caso / Contagious bovine pyelonephritis in Holstein cow: a case report / Pielonefritis bovina constagiosa en vaca holandesa - Relato de caso

O presente estudo foi conduzido com o objetivo de relatar um caso de pielonefrite contagiosa na espécie bovina. Uma fêmea bovina holandesa de 600 kg e que havia parido há 20 dias apresentava sinais clínicos de apatia, anorexia, sialorreia, normoquesia, disúria, diminuição da ingestão de água e bruxismo. No exame físico apresentou taquipneia, taquicardia e temperatura retal elevada. Foi realizada uma ruminotomia para descartar reticuloperitonite. Na laparotomia exploratória notou-se o rim esquerdo hiperatrofiado com ausência de lobulação, dor à palpação e espessamento da parede da bexiga. O tratamento instituído foi com o antibiótico penicilina. O diagnóstico presuntivo foi pielonefrite contagiosa, sendo concluído com base nos sinais clínicos e na resposta imediata ao tratamento, corroborando com o caso descrito.

This study was conducted in order to report a case of contagious pyelonephritis in cattle. A 600-kg female Holstein cow, calved 20 days before, presented clinical signs of lethargy, anorexia, drooling, normoquesia, dysuria, decreased water intake and bruxism. On physical examination, it showed tachypnea, tachycardia and pyrexia. Ruminotomia was performed to rule out a diagnosis of reticuloperitonite. During an exploratory laparotomy, hypertrophy in the left kidney with no lobulation, pain on palpation and thickening of the bladder wall was noticed. The treatment was performed with penicillin. The presumptive diagnosis was contagious pyelonephritis, and it was completed based on the clinical signs and the immediate response to treatment, supporting the case described.

Este estudio se realizó con el objetivo de informar un caso de pielonefritis bovina contagiosa. Una hembra bovina holandesa de 600 kg y que había parido hacía 20 días presentaba signos clínicos de apatía, anorexia, salivación, normoquesia, disuria, disminución de ingestión de agua y bruxismo. En la exploración física presentó taquipnea, taquicardia y fiebre. Se realizó ruminotomia para descartar reticuloperitonitis. En la laparotomía exploradora se observó el riñón izquierdo hipertrofico sin lobulación, dolor a la palpación y engrosamiento de la pared vesical. El tratamiento fue con penicilina. El diagnóstico presuntivo fue pielonefritis contagiosa, que se completó con base en los signos clínicos y en la respuesta inmediata al tratamiento, corroborando con el caso descrito.

Emphysematous pyelonephritis: our experience with conservative management in 14 cases

Emphysematous pyelonephritis [EPN] is a rare, severe, acute, necrotizing infection of the kidney. In this study, we present the clinical details, the management strategies, and the outcome of fourteen patients of EPN managed at our center. A retrospective analysis of the hospital records was done. A total of fourteen patients with EPN were admitted in our hospital from August 2007 to February 2011. All the patients were managed conservatively. Follow-up ranged from six months to one year. Of the fourteen patients, four belonged to class I, five to class II, four to class III A and one to class III B. All the patients had history of fever, 43% had localized flank pain while 36% had vague abdominal discomfort. Renal angle tenderness was the most common sign, seen in 86% of the patients. E. coli was the most common bacteria, which was isolated from urine in 57% of the patients. On the risk factor stratification, three patients had simultaneous presence of 2 or more risk factors [thrombocytopenia-2 patients; renal function impairment-7 patients; shock-1 patient]. All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad spectrum antibiotics. Intervention, in the form of percutaneous drainage or DJ stenting, was done in six patients. One patient failed to respond to this minimally invasive modality of treatment and had to undergo an open drainage. Thus, the acute episode was managed with conservative management strategies in all the patients; however, three patients underwent nephrectomy due to poorly-functioning kidney during follow-up. EPN is now being more readily diagnosed, at an early stage, making conservative management of EPN a safe, effective, and feasible option.

Una lesión en el cintigrama renal DMSA 6 meses post fase aguda de una pielonefritis representa siempre una cicatriz: un debate abierto / Evolution of scintigraphic renal lesions in children after an episode of acute pyelonephritis

Background: Abnormal Dimercaptosuccinic acid (DMSA) renal scintigraphy performed six months after an acute pyelonephritis (AP) is generally interpreted as scarring. Aim: To perform a follow up of childhood patients showing scintigraphic renal lesions during the acute phase of pyelonephritis (within 7 days from the beginning of fever). Material and Methods: A scintigraphic control was carried out at 5-7 months and, in case of persistent lesions, an additional late scintigraphy at 10-13 months. All patients were followed clinically for one year and those with a relapse of urinary tract infection were excluded from the study. Results: Eighty five patients with a median age of 8 months were included. Among these, the first scintigraphic control was normal in 59 (69%) and abnormal in 26 patients (31%). In five of these 26 patients (5/26:19%-5/85: 6%), a considerable regression of the lesions was obvious on the early control, and normalized completely on the late control. When expressing the results in kidney units, 107 showed lesions during the acute phase of infection; 69% was normal at the early control. Thirty three showed lesions persisting at the early control (31%) and 7 out of these 33 (21%) became normal on the late control (7/107: 7%). In total, 25% of the children included in the study (24% of the kidney units) remained with renal sequelae one year after the initial episode of AP. Conclusions: The persistence of scintigraphic lesions six months after an episode of AP, does not necessarily correspond to permanent scars, since normalization can sometimes be observed on late controls.

Solitary renal actinomycosis

A 53-year-old man, who was a recurrent stone former and diabetic, presented with left flank pain, pyuria, and fever. He had undergone multiple interventions for removal of the left kidney stones and retained ureteral double-J stent. All blood and urine investigations were unremarkable and negative for fungus and tuberculosis. Computed tomography scan revealed an edematous left kidney with poorly enhancing upper pole having dilated calyces with hyperdense contents suggestive of abscess [Figure 1]. Ultrasonography-guided aspiration of left renal abscess grew Pseudomona Aeruginosa. Thereafter, patient underwent left laparoscopic nephrectomy. On gross examination, yellow sulfur granules in the dilated upper pole calyceal system were seen [Figure 2]. Microscopic examination of the sulfur granules demonstrated homogenous eosinophilic hyaline material coating actinomyces colonies surrounded by a dense lymphoplasmacytic infiltrate [Splendore-Hoeppli phenomenon] with concomitant pyelonephritis [Figure 3]. The patient was discharged on long-term doxycycline as he was allergic to penicillin. Solitary renal actinomycosis can present as pyelonephritis, renal/perinephric abscess, or renal mass. [1] Multiple interventions, recurrent urinary tract infection, retained double-J stent, uncontrolled diabetes mellitus, and untreated dental caries are predisposing factors for this disease. With development of effective antibiotics, the challenge now lies in the clinician's ability to make the correct diagnosis, thus, ensuring timely recognition and renal salvage if possible[2]

[Characteristics of emphysematous pyelonephritis: about four observations]

Emphysematous pyelonephritis is a severe infection which necessitates a management that is both medical and surgical. Early systematic antibiotic therapy is required. Percutaneous drainage is now the first urological approach in most cases. It should not however delay, if necessary, an eventual nephrectomy. We report our experience during 15 years in four women

Pielonefrite pseudotuberculosa associada a nefrolitíase: relato de seis casos / Pseudotuberculous pyelonephritis associated with nephrolithiasis: report on six cases

Os autores apresentam seis casos de pacientes com história de litíase renal (cálculos coraliformes em quatro), infecçäo urinária de repetiçäo em todos, sem antecedentes ou clínica sugestiva de tuberculose pulmonar ou renal. Idade média de 47,5 anos, predomínio do sexo feminino (2:1). Todos foram submetidos a nefrectomia devido à presença de pielonefrite crônica complicada e apresentaram no exame anatomopatológico granulomas epitelióides similares à tuberculose renal. A pesquisa de bacilos álcool-ácido resistentes por meio de coloraçöes específicas e pelo estudo de DNA (Polimerase Chain Reaction - PCR) foi negativa. Acreditamos ser importante a divulgaçäo dessa forma peculiar de pielonefrite crônica, evitando diagnóstico incorreto de tuberculose renal e tratamento desnecessário

Aspectos da patologia renal em pacientes de 60 ou mais anos de idade / Aspects of renal pathology in 60-year-old patients or older

O presente trabalho descreve as lesöes anátomo-patológicas observadas em biópsias e peças de nefrectomia de pacientes de 60 ou mais anos de idade, analisadas no Departamento de Anatomia Patológica e Medicina Legal (APM) da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), no período de 1980 a 1991. Foi determinada a prevalência de casos de pacientes idosos nefropatas, dentro da casuística global e de patologia renal desse serviço, bem como a frequência e distribuiçäo segundo idade, sexo e tipo de lesöes renais. Foi observado que as biópsias e peças de nefrectomia dos pacientes com 60 ou mais anos de idade constituem apenas 3 por cento do material analisado no serviço, no período de 12 anos. Ao sexo feminino corresponderam 64 casos (54,2 por cento) e ao masculino 54 (45,8 por cento). A doença glomerular foi a mais comum (51 por cento) dentro das patologias observadas, sendo a grande maioria glomerulopatias primárias (92 por cento); em 10 casos (8 por cento) as lesöes glomerulares estavam associadas a doenças sistêmicas. Em segundo lugar, encontrou-se a pielonefrite cronica (17,8 por cento) e posteriormente o carcinoma de células renais (8,5por cento). Em conclusäo, a análise dos resultados do presente estudo mostra que a patologia renal em idosos é variada, sendo as glomerulopatias primárias as lesöes mais frequentes.

Pielonefritis crónica pseudotuberculosa: presentación de un caso y revisión de la literatura / Chronic pseudotuberculous pyelonephritis: report of a case and review of the literature

Este trabajo reporta el caso clínico de una mujer de 68 años de edad con un tipo de pielonefritis granulomatosis muy poco frecuente, asociada con nefrolitiasis. El informe anatomo-patologico de la nefrectomía demostró: Litiasis renal, pionefrosis y múltiples granulomas caseosos que contenían células multinucleadas similares a la TBC renal. No se encontraron bacilos tuberculoos ni otros micro-organismos en los urocultivos pre y post-operatorios, así como tampoco en el tejido renal. En la secreción purulenta del riñon se aisló E.coli

case of xanthogranulomatous pyelonephritis, portal hypertension and chronic calcular cholecystitis

Xanthogranulomatous Pyelonephritis is an uncommon and atypical form of chronic pyelonephritis with segmental or diffuse changes of the renal parenchyma[1,2]. These changes may involve the perinephric fat and may extend to other retroperitoneal organs[3]. Here we present another case. The patient admitted with massive hematemesis due to portal hypertension, was also discovered to have calcular cholecystitis, while the diagnosis of the renal condition was only confirmed after surgical exploration