Mon-322 Emphysematous Pyelonephritis Presenting With Acute Kidney Injury, Treated With Antibiotics in a Black Woman in Sub-Saharan Africa – A Case Report

Abstract

In AKD group, we had 7 class IV lupus nephritis patients with median SLEDAI score of 16 (IQR, 14-18), nephrotic flare (median 24h proteinuria 3.6g) and 6/7 AKD had infections (4 pulmonary, 2 gastrointestinal) on admission. Their infections were complicated by clinical thrombotic microangiopathy (TMA) (defined as elevated D-Dimer, LDH, hemolytic anemia, schistocytes, thrombocytopenia). 5/6 TMA were proven by kidney biopsy. They were started with broad spectrum antibiotics, heparin, tapered steroid, therapeutic plasma exchange (2/7) or plasma infusion (5/7) and hemodialysis (HD) (as needed). A/H1N1 influenza was diagnosed at the rebound fever with normal white blood count (WBC) after the primary response to antibiotics. In ESRD group, we had 6 patients admitted because of infection which 3/6 pneumonia complicated by acute respiratory failure, 2/6 gastrointestinal and 1/6 skin infection. Overall, symptoms of A/H1N1 Influenza infection were not specific with fever (100%), cough (84.6%), dyspnea (61.5%), rhinorrhea (15.4%), bodyache (15.4%), sorethroat (7.7%), and diarrhea (15.4%). No one received influenza vaccination. Mechanical ventilation was required in 3 ESRD (in which 2 death) and 2 AKD. All were isolated and under multidisciplinary care with oral 7-day oseltamivir. Three months after discharge, 4 ESRD continued HD, 7 AKD reached partial remission of kidney function with (1) 6/6 withdrew HD, (2) 7/7 decreased Scre >50% from peak (Scre of 3.0 mg/dL (IQR, 2.3-5.2) to 1.9 mg/dL (IQR,1.5-2.3 at 3 month).