Pyuria without Casts and Bilateral Kidney Enlargement Are Probable Hallmarks of Severe Acute Kidney Injury Induced by Acute Pyelonephritis: A Case Report and Literature Review

Abstract

The patient was a 38-year-old man who had experienced nausea and fever for a few days and presented with back pain, oliguria, and pyuria, suggesting acute pyelonephritis (APN). He showed acute kidney injury (AKI) with bilateral kidney enlargement and was using nonsteroidal anti-inflammatory drugs (NSAIDs). AKI-induced by APN was confirmed by kidney biopsy. The AKI was successfully treated with antibiotic therapy. A search of the relevant literature for reports on histopathologically-proven APN-induced severe AKI revealed that the key characteristics were bilateral kidney enlargement with pyuria without casts. Oligoanuria was frequently associated with APN-induced severe AKI, and NSAID use may be a possible risk factor. Prompt antibiotic treatment based on the clinical characteristics of APN-induced AKI can improve the renal outcome.

Bilateral nephromegaly due to direct leukemic cell invasion in the initial and relapse phases of T-cell acute lymphoblastic leukaemia

“…[5] In our case, since the patient had renal dysfunction with abnormal cells in circulation and bicytopenia, it was obvious that he had hematological disease. Bilateral nephromegaly can be caused by various conditions, such as diabetes mellitus, [11] acute glomerulonephritis, [12] acute interstitial nephritis, [13] acute tubular necrosis, [14] rapidly progressive glomerulonephritis, [15] and HIV-associated nephropathy, [16] amyloidosis, [17] malignant or benign infiltrative diseases (multiple myeloma, lymphoma, leukemia, and renal metastasis [18] ), bilateral hydronephrosis, and cystic diseases. Although the incidence is low, renal infiltration by acute leukemia is an important differential diagnosis, even in adult patients.…”