Successful Medical Treatment of Emphysematous Pyelonephritis in a Renal Allograft Recipient

Baliga, K.V.; Narula, AS; Sharma, Ambudhar; Khanduja, R.; Manrai, Manish; Debnath, Jyotindu; Sandhu, A.S.

doi:10.1080/08860220701460434

Cited by 18 publications

(12 citation statements)

References 10 publications

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“…Since it carries a grave prognosis, early suspicion and treatment of this entity is of paramount importance. Although EPN occurs almost exclusively in patients with diabetes mellitus (DM) [1], and occasionally in patients with obstructive uropathy [2,3], the disease has also been reported in renal allografts [4][5][6][7]. It mostly affects females due to increased susceptibility to UTI in females and chills and fever are the most common presenting features (56%), followed by flank pain (48%).…”

Section: Introductionmentioning

confidence: 94%

Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis

et al. 2009

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Section: Introductionmentioning

confidence: 94%

Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis

et al. 2009

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“…In a meta‐analysis involving 7 studies with 175 patients, the overall mortality rate was 25%, ranging from 11% to 42% in native kidney EPN . Of the 20 cases (including our current report) in the English‐language literature of EPN in renal allografts (Table ) , 13 (65%) had extensive disease (≥Class 3 by Huang & Tseng classification ). Our patient had extensive disease, with large perinephric and retroperitoneal collections with air pockets displacing the ascending colon and bladder classifying her as Class 3B, with acute kidney injury and impaired consciousness as risk factors.…”

Section: Discussionmentioning

confidence: 69%

Extensive emphysematous pyelonephritis in a renal allograft treated conservatively: case report and review of the literature

Schmeißer

Varughese

David

et al. 2012

Transplant Infectious Dis

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Emphysematous pyelonephritis (EPN) is a rare occurrence in renal allografts. An aggressive approach resulting in transplant nephrectomy is viewed as the standard of care. Over the recent years, treatment with percutaneous drainage (PCD) of the renal and perinephric collections and appropriate antibiotics has been reported with good success in lesser grades of this infection. Only 4 cases of extensive EPN disease with Escherichia coli, treated with conservative management, are reported in the English-language literature. We present a case of severe EPN caused by Klebsiella pneumoniae, successfully managed with early PCD, and propose a step-up strategy aimed toward graft preservation.

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“…Two cases of successful medical treatment of EPN in renal transplant patients have recently been reported. One patient had class 2 EPN with fewer co‐morbidities than our patient, and was successfully treated with IV antibiotics alone (15). The other patient was successfully treated with percutaneous drainage and IV antibiotics (16).…”

Section: Discussionmentioning

confidence: 75%

Iatrogenic emphysematous pyelonephritis in a renal transplant patient

Boltan

Randall²,

Barri

2008

Transplant Infectious Dis

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Emphysematous pyelonephritis (EPN) is a rare condition that typically occurs in patients with diabetes mellitus, urinary tract obstruction, or immunosuppression such as solid organ transplant recipients. It has high mortality and frequently requires nephrectomy to achieve cure, although percutaneous drainage has been reported to be successful in some patients. We report a renal transplant recipient with underlying diabetes mellitus who developed iatrogenic EPN. The patient initially presented with dyspnea and was admitted for cardiac evaluation. There was no evidence of urinary tract infection at the time of admission. The patient developed high-grade fever 3 days after admission. Despite intravenous (IV) antibiotic therapy, the patient developed acute renal failure requiring hemodialysis. Studies revealed Klebsiella bacteremia and EPN. We believe that urinary tract infection was precipitated by urinary bladder catheterization performed on the day of admission. Despite 2 weeks of IV antibiotic therapy, infection persisted with progressive extension of gas into the perinephric space on repeat imaging. The patient underwent a transplant nephrectomy with subsequent clinical recovery. This case illustrates that antibiotics alone are often inadequate to cure and preserve renal function in EPN despite immediate therapy. Furthermore, this patient underscores the risk of serious infection precipitated by urinary bladder catheterization in immunocompromised patients.

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Successful Medical Treatment of Emphysematous Pyelonephritis in a Renal Allograft Recipient

Cited by 18 publications

References 10 publications

Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis

Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis

Extensive emphysematous pyelonephritis in a renal allograft treated conservatively: case report and review of the literature

Iatrogenic emphysematous pyelonephritis in a renal transplant patient

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