RESUMEN
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.
Asunto(s)
Cistitis , Enfisema , Trasplante de Riñón , Pielonefritis , Cistitis/etiología , Enfisema/etiología , Humanos , Riñón , Trasplante de Riñón/efectos adversos , Pielonefritis/etiologíaAsunto(s)
Enfisema/diagnóstico , Enfermedades Renales Quísticas/diagnóstico , Riñón/diagnóstico por imagen , Infecciones por Klebsiella/diagnóstico , Pielonefritis/diagnóstico , Anciano , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/microbiología , Diagnóstico Diferencial , Farmacorresistencia Bacteriana Múltiple , Enfisema/microbiología , Humanos , Riñón/microbiología , Riñón/patología , Enfermedades Renales Quísticas/complicaciones , Enfermedades Renales Quísticas/microbiología , Infecciones por Klebsiella/complicaciones , Klebsiella pneumoniae/aislamiento & purificación , Klebsiella pneumoniae/patogenicidad , Masculino , Pielonefritis/microbiología , Tomografía Computarizada por Rayos X , beta-Lactamasas/metabolismoRESUMEN
INTRODUCTION: Emphysematous pyelonephritis (EPN) is a rare and severe, necrotizing infection of the kidney. Diagnosis should be precocious based on computed tomography (CT). Its management remains controversial and its treatment is currently increasingly conservative. The aim of this paper is to discuss the conservative treatment of this disease through our experience in 21 patients. MATERIAL AND METHODS: A retrospective analysis including 21 patients managed conservatively for an emphysematous pyelonephritis in our department from January 2010 to April 2015. Follow-up ranged from three to 24 months. RESULTS: Of the 24 patients, seven belonged to class 1, twelve to class 2 and two to class 4. Obstruction of the upper urinary tract was found in 16 cases. On the risk factor stratification, thrombocytopenia was found in five cases, renal function impairment in 10 cases and a septic shock in four cases. All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad-spectrum antibiotics. Drainage of the urinary tract was performed by double-J stent in 14 patients and with ureteral catheter in six patients. One patient had urinary distension secondary to a urethral stricture with bilateral emphysematous pyelitis. In this case, drainage consisted in suprapubic bladder catheter only. The outcome was favorable in 18 patients and the control CT showed a decline or complete disappearance of gas in urinary tract and/or renal parenchyma after an average period of 12 days. A secondary nephrectomy was performed in two cases. Specific mortality rate was zero. CONCLUSION: PNE remains a severe infection involving the vital prognosis. Computed tomography makes an early diagnosis. Treatment should be conservative based on the association of medical intensive care and drainage, percutaneous or endoscopic, urgently. Nephrectomy should be reserved for extensive forms with multiple organ dysfunction or failure of conservative treatment.