Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi

ABSTRACT Introduction: To investigate the role of initial procalcitonin (PCT) level as an early predictor of septic shock for the patient with sepsis induced by acute pyelonephritis (APN) secondary to ureteral calculi. Materials and Methods: The data from 49 consecutive patients who met criteria of sepsis due to APN following ureteral stone were collected and divided into two groups: with (n=15) or without (n=34) septic shock. The clinical variables including PCT level for this outcome were retrospectively compared by univariate analysis, followed by multivariable logistic regression model. Results: All subjects had hydronephrosis, and were hospitalized with the mean of 11.8 days (3–42 days). The mean size of the ureteral stones was 7.5mm (3–30mm), and 57% were located in upper ureter. At univariate analysis, patients with septic shock were significantly older, a higher proportion had hypertension, lower platelet count and serum albumin level, higher CRP and PCT level, and higher positive blood culture rate. Multivariate models indicated that lower platelet count and higher PCT level are independent risk factors (p=0.043 and 0.046, respectively). In ROC curve, the AUC was significantly wider in PCT (0.929), compared with the platelet count (0.822, p=0.004). At the cut-off of 0.52ng/mL, the sensitivity and specificity were 86.7% and 85.3%. Conclusion: Our study demonstrated elevated initial PCT levels as an early independent predictor to progress into septic shock in patients with sepsis associated with ureteral calculi.

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