Pielonefritis enfisematosa / Emphysematous pyelonephritis

La pielonefritis enfisematosa es una enfermedad poco frecuente. Esta consiste en una infección necrotizante severa del parénquima renal asociada a formación de gas en el sistema colector, parénquima renal y/o tejidos perirrenales. Se presenta una paciente de 54 años de edad con antecedentes de diabetes mellitus tipo 2 no controlada y litiasis urinaria, atendida en el Cuerpo de Guardia del Hospital Celia Sánchez Manduley, Granma, Cuba. Presentaba náuseas y vómitos, dolor en ambos lados de la región lumbar, y fiebre. La ecografía mostró riñones hiperecogénicos e imágenes ecorefringentes en proyección de las cavidades renales. El cultivo de orina probó la presencia de escherichia coli, y se medicó de forma endovenosa. Por evolución no favorable, se realizó tomografía que evidenció patrón gaseoso en cavidades renales. Se reajustó la antibioticoterapia parenteral y la evolución fue favorable. Se dio alta de consulta, luego de 10 meses de seguimiento asintomática, con diagnóstico de pielonefritis enfisematosa(AU)

Emphysematous pyelonephritis is a rare disease, consisting of severe necrotizing infection of the renal parenchyma associated with gas formation in the collecting system, renal parenchyma and / or peri renal tissues. We report a 54-year-old patient with history of uncontrolled type 2 diabetes mellitus and urinary stones, she was treated in the emergency service at Celia Sánchez Manduley Hospital, Granma, Cuba. She had nausea and vomiting, pain on both sides of her lower back, and fever. Ultrasound showed hyper-echogenic kidneys and echo-refractive images in projection of the renal cavities. The urine culture proved the presence of Escherichia coli, and medications was administered intravenously. Due to the unfavorable evolution, a tomography was performed and it showed a gas pattern in the renal cavities. Parenteral antibiotic therapy was readjusted and the outcome was favorable. After 10 months of asymptomatic follow-up, she was discharged from the clinic with diagnosis of emphysematous pyelonephritis(AU)

Tratamiento de la litiasis renal con nefrolitotomía percutánea con láser en la población pediátrica: experiencia inicial / Treatment of kidney stones using percutaneous nephrolithotomy with laser in a pediatric population: an initial experience

Reportar nuestra experiencia inicial de nefrolitotomía percutánea (NLPC) con láser Holmium para el tratamiento de litiasis renal en la población pediátrica. Material y métodos: Estudio retrospectivo descriptivo de pacientes menores de 16 años con litiasis renal que fueron tratados con nefrolitotomía percutánea en el servicio de Urología del Hospital Garrahan en el período comprendido entre agosto de 2013 y marzo de 2015. Resultados: 19 procedimientos en 16 pacientes con un número de 17 unidades renales (UR) con una edad media de 7 años y un rango de 2 a 15 (Tabla 2). Los tipos de litiasis tratadas fueron: litiasis coraliforme en 6 pacientes (37,5%), coraliforme incompleto en 3 pacientes (18,7%), litiasis piélicas mayores de 2 cm en 4 pacientes (25%), litiasis piélicas menores de 2 cm en 2 pacientes (12,5%) y múltiples mayores de 2 cm en 1 paciente (6,25%). Se realizó acceso único en 15 pacientes, en sólo uno se configuró un segundo acceso y se reingresó o se realizó cirugía en dos tiempos en 3 pacientes (todos con litiasis coraliforme completa). La tasa de litiasis residual total fue del 21,1 %, todas ellas en litiasis coraliformes completas. Las complicaciones se observaron en 3 casos (18,7%) y fueron clasificadas como tipo III B en dos pacientes y del tipo I en uno. En los dos primeros se requirió conversión a vía abierta y en el último paciente solo se dejó colocada nefrostomía por 7 días. La internación promedio fue de 2,8 días con un rango de 1 a 15 días. El seguimiento medio fue de 7 meses con un rango de 4 a 13 meses. Conclusiones: La nefrolitotomía percutánea en pediatría es un método con baja morbilidad, que requiere una curva de aprendizaje prolongada y es determinante contar con todo el material necesario para "liberar" al riñón de litiasis urinaria (AU)

The aim of the study was to report our initial experience with percutaneous nephrolithotomy (PCNL) with holmium laser for the treatment of kidney stones in children. Material and methods: A descriptive retrospective analysis was conducted in patients younger than 16 years with kidney stones treated with PCNL at the department of urology of Garrahan Hospital between August 2013 and March 2015. Results: 19 procedures were performed in 16 patients with a number of 17 renal units (RU) and a mean age of 7 years, ranging from 2 to 15 years (Table 2). Types of kidney stones were: Staghorn kidney stones 6 patients (37.5%), partial staghorn kidney stones in 3 patients (18.7%), renal pelvis kidney stones larger than 2 cm in 4 patients (25%), renal pelvis kidney stones smaller than 2 cm in 2 patients (12.5%), and multiple kidney stones larger than 2 cm in 1 patient (6.25%). A single tract was performed in 15 patients, a second tract in only one, and re-entry or a two-step surgery was performed in 3 patients (all with complete staghorn kidney stones). The rate of residual stones was 21.1 %, all of them were complete staghorn stones. Complications occurred in 3 cases (18.7%) and were classified as type III B in two patients and type I in one. In the first two patients conversion to open surgery was necessary and in the remaining patient the nephrostomy was left in place for 7 days. Mean hospital stay was 2.8 days with a range of 1 to 15 days. Mean follow-up time was 7 months with a range of 4 to 13 months. Conclusions: In children PCNL is a procedure with low morbidity requiring a long learning curve. Availability of all the necessary materials is essential to be able to "release" the kidney from the stones (AU)

Laterality of symptomatic recurrent calcium nephrolithiasis

Although it is presumed that both kidneys excrete similar urinary constituents, it is a general observation that the majority of patients present with unilateral stone disease. The aim of this work was to study the laterally of recurrence in calcium stone formers. In a retrospective study of 154 patients treated for recurrent symptomatic nephrolithiasis at our institution between January 1982 and December 2006, the side of stone formation was determined by an analysis of radiographic findings and symptomatic history. Patients with hydronephrosis, major renal anatomic anomalies and non-calcium stones were excluded from the study. The features of unilateral stone forming and bilateral stone forming were compared. Statistical analysis was done using Student's t-test. Of the 154 patients, 102 were males and 52 females with a male-to-female ratio of 1:2. One hundred and fourteen patients had unilateral stones [Group A], 64 [56%] on the left and 50 [44%] on the right side. In 40 patients they were bilateral [Group B]. Comparing Groups A and B, the mean age at the first stone episode was 41.5 versus 38.3 years, the mean interval between the first stone and recurrence was 9.6 versus 9.9 years, and the mean follow-up was 13.3 versus 14.9 years [differences not statistically significant]. In Group A, 101 patients [89%] had unilateral stone recurrence episodes with 86 of these 101 patients [85%] developing stones on the same side as the primary stone. Of the 40 patients with bilateral stone formation, 30 patients [75%] had bilateral stone recurrence episodes. Recurrent stone formers commonly present with calculi on the same side and the etiology of this phenomenon is unclear, but anatomic and external triggers should be considered