Bilateral ureteric obstruction secondary to renal papillary necrosis.

A 2-year-old male presented to hospital with a 5-day history of vomiting and pyrexia. He was initially treated with non-steroidal medication as an anti-pyretic. Initial investigations demonstrated a raised urea and creatinine and he was treated with intravenous fluids. Within 24 h he became anuric with progressive renal insufficiency. Ultrasound scan demonstrated minimal bilateral hydronephrosis with debris in the lower pole calyces. The bladder was empty. Cystoscopy and retrograde contrast imaging revealed bilateral ureteric obstruction. Double J stents were inserted and his renal function returned to normal within 4 days. We believe the aetiology to be renal papillary necrosis and bilateral ureteric obstruction secondary to the administration of ibuprofen in association with dehydration.

Papillary necrosis causing hydronephrosis in renal allograft treated by percutaneous retrieval of sloughed papilla.

Obstructive uropathy is the second most common urological complication in a transplanted kidney. The usual causes of obstruction are ureteral stenosis and calculi. Papillary necrosis as a cause of obstruction in a transplant kidney is extremely rare with only one prior report published. Moreover, percutaneous removal of sloughed papilla in a transplant kidney has not previously been reported. We report an unusual case of a sloughed papilla causing hydronephrosis of a transplant kidney and its successful percutaneous removal. The recognition of renal papillary necrosis is important, not only because it can be a sign of acute rejection but also it because it can lead to obstruction, infection and potentially the loss of the transplant as exemplified by our case. Rapid diagnosis and meticulous retrieval technique are the crucial factors in minimizing the complications due to obstruction of a transplanted kidney by sloughed papilla.

Emphysematous pyelonephritis: clues to rapid diagnosis in the Emergency Department.

Emphysematous pyelonephritis (EPN) is an acute life-threatening bacterial infection. EPN leads to rapid necrotizing destruction of the renal parenchyma and peri-renal tissue, requiring early and aggressive care to reduce morbidity and mortality. Previous studies have described the use of computed tomography scan and radiology-performed ultrasound to make the diagnosis of EPN We report a case of EPN diagnosed by bedside Emergency Department (ED) ultrasound performed by emergency physicians, allowing a more rapid diagnosis and subsequent treatment.

[Emphysematous pyelonephritis with favourable outcome after conservative treatment]. / Une pyélonéphrite emphysémateuse d'évolution favorable après traitement conservateur.

Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis is responsible for a high mortality rate. We report the case of a woman, unknown diabetic, who presented with emphysematous pyelonephritis. Early diagnosis performed by CT-scan allowed effective and conservative surgical treatment and final positive outcome.

Phenacetin-induced renal papillary necrosis: pyonephros, anuria, and bilateral ureteral obstruction.

A fifty-five-year-old man was seen with anuria. Retrograde pyelograms demonstrated bilateral ureteral obstruction subsequently shown to have resulted from sloughed renal papillae. A twenty-year history of phenacetin was obtained. Treatment included bilateral ureteral intubation, then ureterotomy on one side.

Urologic complications of renal papillary necrosis.

Fifty-six patients demonstrating roentgenographic evidence of renal papillary necrosis were reviewed. Seven patients had an acute fulminating form of the disease. Urologic complication incident to sloughed renal papillae required urgent surgical intervention. Management ranging from ureteral catheterization to nephrectomy in 3 of 7 patients is discussed, and associated disease states are scrutinized.

[Nephrectomy in acute uncomplicated pyelonephritis]. / Nephrektomie bei akuter unkomplizierter Pyelonephritis.

BACKGROUND: Which complications can develop from uncomplicated pyelonephritis that may require nephrectomy? METHODS: From January 1999 to June 2003 we carried out nephrectomy in ten cases due to abscess formation after acute, uncomplicated pyelonephritis. The medical files were evaluated retrospectively. RESULTS: Nine women and one man were involved. The mean age was 36.2 years. Leading symptoms: flank pain, fever and chills. The mean symptom duration before admission was 14.6 days. Urinary tract infections were caused by Escherichia coli (six), E. coli and Enterococcus (once) and Klebsiella pneumoniae (once). Two cultures were sterile. Indications for nephrectomy were urosepsis (7 cases), anuria (once), increasing abscess formation under antibiotic therapy (once), drastic deterioration of general condition (once). CONCLUSIONS: Uncomplicated pyelonephritis is easy to treat under outpatient conditions with adequate oral antibiotic therapy. Close control must be ensured and clear recovery of symptoms should occur within 48 h. In the case of long duration of symptoms (>6-7 days) or lack of improvement of symptoms under calculated therapy in the first 2 days, inpatient therapy should be initiated because of the high risk of infectious complications. According to our experience, the following patient group is especially at risk: female, symptom duration of at least approximately 1 week, pre-treatment and transfer from another departments.

[Renal papillary necrosis cured with endourological treatment].

We recently experienced a case of renal papillary necrosis which we removed by endourological treatment. A 58-year-old female diabetic patient complaining of left flank pain, fever and chills was admitted to our clinic. She had no past history of analgesic abuse or atypical vasculitis. Physical examination revealed a body temperature of 38 degrees C and tenderness in the left costovertebral angle. Pyuria was noted, and urine cultures grew more than 100,000 colonies of Escherichia coli per cubic millimeter. DIP revealed a diminished renal function, hydronephrosis, distorted middle and lower calyces and filling defect in the dilated ureter. However, there was no evidence of obstruction or ureteral reflux. Retrograde pyelography confirmed distortion and irregularity of the calyces and hydronephrosis due to a shadow defect which was movable during radiographic examinations. Laboratory studies revealed anemia, leucocytosis and hyperglycemia, but no elevation of BUN. Therefore, the patient was diagnosed as renal papillary necrosis. We succeeded in its endourological removal through nephrostomy with a choledochoscope (Olympus Co.) under epidural anesthesia. After surgery, the patient made a satisfactory recovery.

Percutaneous embolic occlusion of an acquired bleeding intrarenal aneurysm.

A diabetic patient presenting with an acquired bleeding aneurysm secondary to a nephrostomy for papillary necrosis was sucessfully treated by super-selective embolic occlusion of the artery supplying the aneurysm.

Torulopsis pyelonephritis associated with papillary necrosis: a case report.

A case of Torulopsis glabrata pyelonephritis associated with papillary necrosis is presented. Torulopsis glabrata is a potential pathogen in the urinary tract capable of producing renal damage, sepsis and death. In this case the involved kidney sustained progressive damage, necessitating nephrectomy for cure. Examination of the kidney showed fungal involvement of the parenchyma and collecting system.

Necrotizing emphysematous pyelonephritis: a case report.

Emphysematous pyelonephritis (EP) is comparatively rare in urological practice. From 1898 to the present time only 45 cases have been described. In this report we describe the case of a 43-year old diabetic man, with right EP without obstruction of the urinary tract and with a urinary infection of E. Coli. This appears to be rather rare as it is more frequently associated with obstruction of the urinary tract. Surgical exploration enabled us to discover a fistula between the kidney and the wall of the vena cava which would have caused fatal complications if it had not been discovered. The micro-organisms more frequently involved were E. Coli, Proteus, Aerobacter and various anaerobes. Mortality has been reported as 75% in patients receiving medical therapy only and 23% in those undergoing surgery. The authors therefore believe that surgical exploration even with no urinary tract obstruction makes it possible to detect complicating pathologies which may remain undiscovered by medical examination and the urinary excretory tract and renal sheath drained. This provides a better opportunity of estimating possible reversibility of the renal lesion.

Emphysematous pyelonephritis.

A case of emphysematous pyelonephritis with perirenal gas is presented. This patient underwent vigorous medical treatment followed by nephrectomy and survived. This condition has a high mortality and should be distinguished from less severe infections where gas is confined to the collecting system. This case and others previously reported suggest that treatment should initially be medical, followed by early surgical intervention consisting of either drainage or nephrectomy depending upon the degree of renal involvement.