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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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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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Emphysematous Pyelonephritis: a Review of a Rare Condition. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0303-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Uruc F, Yuksel OH, Sahin A, Urkmez A, Yildirim C, Verit A. Emphysematous pyelonephritis: Our experience in managing these cases. Can Urol Assoc J 2015; 9:E480-3. [PMID: 26279720 DOI: 10.5489/cuaj.2828] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) is a rare acute necrotising infection of renal parenchyma. We discuss clinical details and treatment strategies of 8 patients with EPN followed at our clinic. METHODS We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 8 patients with EPN followed at our urology clinic between 2012 and 2015. RESULTS The mean patient age (female: 5; male: 3) was 62 (range: 51-82) years. Based on computed tomographic findings, EPN was classified as class 1 (n = 3), class 2 (n = 3) and class 3a (n = 2). All patients had fever, flank pain, nausea, and vomiting. Five patients had type 2 diabetes mellitus and 3 diabetic patients also had renal stones. Escherichia coli (n = 6), Klebsiella species (n = 1), and Proteus species (n = 1) were grown in urine cultures. All patients had unilateral involvement. Increased white blood cell counts, sedimentation rate, and C-reactive protein levels were detected in all cases. In addition to medical treatment, 2 patients underwent a nephrostomy catheter placement and another 2 patients underwent nephrectomy upon deterioration of her general health state. After achieving clinical stabilization with medical treatment, 1 patient underwent endoscopic ureteral stone treatment. The remaining 3 cases were treated only with antibiotherapy. All patients were discharged with clinical cure. CONCLUSION Mortality rates of EPN are gradually decreasing. Preservation of renal reserve is possible due to early diagnosis, appropriate antibiotherapy, and drainage.
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Affiliation(s)
- Fatih Uruc
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
| | | | - Aytac Sahin
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
| | - Ahmet Urkmez
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
| | - Caglar Yildirim
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
| | - Ayhan Verit
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
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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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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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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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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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Fujita S, Watanabe J, Reed AI, Hemming AW, Solis D, Netzel TC, Banull K, Schain DC, Howard RJ. Case of emphysematous pyelonephritis in a renal allograft. Clin Transplant 2005; 19:559-62. [PMID: 16008605 DOI: 10.1111/j.1399-0012.2005.00264.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Emphysematous pyelonephritis is a rare, but serious complication after renal transplantation. This is a case report of a 49-yr-old female who had a renal transplant for diabetic nephropathy. She presented to ER with about 1 wk history of right lower abdominal pain and fever 15 months after the transplant. She had gross hematuria and mental status changes just prior to presentation. A computed tomography (CT) scan of the abdomen showed extensive retroperitoneal and extraperitoneal air dissecting from the transplanted kidney in the right lower quadrant to the level of the mediastinum. There was air in the urinary bladder. These findings were highly suggestive of extensive emphysematous pyelonephritis. The patient was taken to the operating room emergently and underwent a transplant nephrectomy. Blood culture and urine culture were subsequently positive for Salmonella (serogroup O 6, 8 or C2). Initial blood culture also yielded Enterobacter cloacae. The patient was treated with imipenem, cefepime, flagyl, and diflucan empirically: this was later changed to complete a 6-wk course of ciprofloxacin upon discharge. Her hospital course was complicated by a urinary leak; she was discharged to home on day 21. This is the 12th reported case of emphysematous pyelonephritis occurred in a renal transplant recipient.
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Affiliation(s)
- Shiro Fujita
- Division of Transplantation, Department of Surgery, University of Flordia College of Medicine, Gainesville, FL 32610-0286, USA.
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Abstract
Emphysematous pyelonephritis is a necrotizing kidney infection characterized by the presence of gas in renal parenchyma, collecting system or perinephric tissue. This rare affection occurs almost exclusively in patients with diabetes mellitus and is due to non-anaerobic gas-producing bacteria. This life-threatening condition leads to septic shock and multiple organ failure. Diagnosis is suspected when a pyelonephritis does not respond to correct treatment, especially with altered vital signs or a diabetic patient. Computed tomography scan permits visualization of the gas and a radiologic classification with a prognostic value. Current treatment modalities are based upon repeated clinical and scanographic evaluations. In addition to systematic antibiotic therapy, percutaneous drainage is probably the first therapeutic stage in the majority of cases, but should not delay emergent rescue nephrectomy if necessary.
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Affiliation(s)
- E Kaiser
- Anesthésiste-réanimateur des Hôpitau des Armées, département d'anesthésie-réanimation, France.
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Narlawar RS, Raut AA, Nagar A, Hira P, Hanchate V, Asrani A. Imaging features and guided drainage in emphysematous pyelonephritis: a study of 11 cases. Clin Radiol 2004; 59:192-7. [PMID: 14746791 DOI: 10.1016/s0009-9260(03)00295-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM The purpose of the present study is to evaluate the role of image-guided drainage in emphysematous pyelonephritis (EPN). MATERIALS AND METHODS We reviewed 11 patients with EPN treated either by ultrasonography (three patients) or computed tomography (CT)-guided drainage (eight patients). There were eight male and three female patients in our study with ages ranging from 24 to 75 years, mean 56.3 years. All the patients underwent plain radiography, ultrasonography and plain CT of the abdomen. Contrast-enhanced CT was performed in seven patients. RESULTS Seven of 11 patients, were successfully treated with per cutaneous drainage. One patient died within 24 h (case 2), due to septicaemia. Three patients subsequently required nephrectomy. Replacement of the drainage catheter was required in one patient. The catheter was kept in situ, for an average of 17 days. The catheter drained pus and gas in all patients. The quantity of pus ranged from 300 to 2000 cm(3). All 10 patients improved symptomatically within 24 h of drainage, with improved urine output and serum creatinine levels within 48 h. CONCLUSION CT-guided drainage of EPN has established itself as a safe, quick and life-saving palliative treatment of choice as opposed to conventional emergency nephrectomy. Excluding the patient who died, the success rate of our study was 70%.
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Affiliation(s)
- R S Narlawar
- Department of Radiology, K. E. M. Hospital, Parel, Mumbai, India
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