Temporal evolution of emphysematous pyelonephritis in a renal allograft: imaging findings

Debnath, Jyotindu; Baliga, K.V.; George, Richard A.; Satija, Lovleen; Khanduja, R.; Vaidya, Ashima; Sandhu, A.S.; Hanagandi, Prasad B.; Sawant, Milind B.

doi:10.1007/s10140-008-0728-z

Cited by 4 publications

(3 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In another case reported by Seiji et al (19), allograft nephrectomy was performed 4 days after the diagnosis of EPN in a hepatitis B‐positive patient, but the patient died 25 days later from fulminant hepatic failure. In the 3 cases in which the management strategy employed was discordant with our staging system, Potter et al (9) treated a patient with Stage 2 disease with allograft nephrectomy and the patient subsequently recovered; Baliga et al (20) reported a patient with Stage 2 disease who responded to antibiotic therapy alone without the need for drainage; and Debnath et al (22) reported a patient with Stage 3 disease who was treated successfully with antibiotic therapy alone, without the need for either drainage or nephrectomy. Although these latter 2 cases demonstrate that patients may be treated successfully with antibiotic therapy alone in either Stage 2 or Stage 3 EPN, it is also important to emphasize that a delay in PCD or surgical therapy in this setting may lead to mortality.…”

Section: Discussionmentioning

confidence: 90%

“…The incidence of EPN in renal allografts is very rare, with only 20 reported cases in the English literature. Data from previously published studies are summarized in Table 2 (1, 3, 4, 7–22). In these reported cases, 90% of patients were diabetic and the timing of EPN was quite variable, ranging from 2 weeks to 11 years after transplantation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Renal allograft failure due to emphysematous pyelonephritis: successful non-operative management and proposed new classification scheme based on literature review

Al-Geizawi

Farney

Rogers

et al. 2010

Transplant Infectious Disease

View full text Add to dashboard Cite

Emphysematous pyelonephritis (EPN) is a rare necrotizing infection of the kidney caused by gas-forming organisms, usually occurs in diabetic patients, and often requires nephrectomy for effective therapy. EPN is rarely reported in renal allografts, with only 20 cases found in the English literature. We report herein a case of EPN in a transplanted kidney resulting in acute renal failure and sepsis. The patient was managed non-operatively with subsequent recovery of renal allograft function. Based on this experience and a review of the literature, we suggest an amended classification system for EPN in kidney transplantation to plan and guide treatment options accordingly. However, the scarcity of this disease process, coupled with the lack of prospective validation of the new classification scheme, prevents drawing definitive conclusions regarding optimal management strategies including the role and timing of allograft nephrectomy.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Renal allograft failure due to emphysematous pyelonephritis: successful non-operative management and proposed new classification scheme based on literature review

Al-Geizawi

Farney

Rogers

et al. 2010

Transplant Infectious Disease

View full text Add to dashboard Cite

show abstract

“…Al‐Geizawi classification stage 1 tends to be treated by antibiotics and stage 2 by antibiotics plus percutaneous drainage (PCD) (Table ) . Stage 3 patients are treated either by PCD or nephrectomy, however, some stage 3 cases deteriorated too quickly to perform transplant nephrectomy .…”

Section: Discussionmentioning

confidence: 99%

Emphysematous pyelonephritis in renal allograft related to antibody‐mediated rejection: A case report and literature review

Takahashi

Malinzak

Safwan

et al. 2018

Transplant Infectious Dis

View full text Add to dashboard Cite

Emphysematous pyelonephritis (EPN) is a rare condition which can rapidly progress to sepsis and multiple organ failure with high mortality. We experienced a rare case of EPN in a renal allograft related to antibody‐mediated rejection (AMR). The patient received a deceased donor kidney transplant due to end‐stage renal disease secondary to diabetes mellitus. Cross‐match test was negative but she had remote history of anti‐HLA‐A2 antibody corresponding with the donor HLA. Surgery concluded without any major events. Anti‐thymoglobulin was given perioperatively for induction. She was compliant with her immunosuppressive medications making urine of 2 L/d with serum creatinine of 1.9 mg/dL at discharge on post‐operative day (POD) 6. She did well until POD 14 when she presented to the clinic with features of sepsis, pain over the transplanted kidney area and decline in urine volume with elevated serum creatinine. CT revealed extensive gas throughout the transplanted kidney. Renal scan revealed non‐functional transplant kidney with no arterial flow. Based on these findings, a decision to perform transplant nephrectomy was made. At laparotomy, the kidney was completely necrotic. Pathology showed non‐viable kidney parenchyma with the tubules lacking neutrophilic casts suggestive of ischemic necrosis. Donor‐specific antibody (DSA) returned positive with high intensity anti‐HLA‐A2 antibody. This is the first case of early EPN in allograft considered to have occurred as a result of thrombotic ischemia secondary to AMR. This case suggests consideration of perioperative anti‐B‐cell and/or anti‐plasma cell therapies for historical DSA and strict post‐operative follow‐up in immunologically high‐risk recipients to detect early signs of rejection and avoid deleterious outcomes.

show abstract

Kidney–pancreas transplantation

Heller

Hattoum

2012

Emerg Radiol

View full text Add to dashboard Cite

For patients with diabetes, insulin therapy can be an effective treatment for years. However, many diabetics eventually develop complications from the disease, including neuropathy, amputations, atherosclerosis, and kidney failure. While kidney failure can be managed with dialysis, difficulties with monitoring fluid intake and diet, bone loss, anemia, and venous access can be problematic for the patient. Due to the decreased life expectancy and difficulties of medical management of patients with diabetes and renal failure, combined renal-pancreas transplantation is an increasingly used option available to type 1 diabetics with concurrent renal failure due to refinements of surgical technique and immunosuppressive therapy. Due to the increasing number of kidney-pancreas transplant patients, longer post-transplant survival, and increasing number of hospitals performing the procedure, more transplant patients are having their care increasingly shifted away from the major transplant centers to general community hospitals. In many kidney-pancreas transplants patients who present to the emergency department for suspected transplant dysfunction, imaging plays a critical initial role in their diagnosis and management. Therefore, it has become increasingly important that community and emergency department radiologists be able to recognize the normal imaging appearance of renal-pancreas transplants and to identify acute findings.

show abstract

Temporal evolution of emphysematous pyelonephritis in a renal allograft: imaging findings

Cited by 4 publications

References 6 publications

Renal allograft failure due to emphysematous pyelonephritis: successful non-operative management and proposed new classification scheme based on literature review

Renal allograft failure due to emphysematous pyelonephritis: successful non-operative management and proposed new classification scheme based on literature review

Emphysematous pyelonephritis in renal allograft related to antibody‐mediated rejection: A case report and literature review

Kidney–pancreas transplantation

Contact Info

Product

Resources

About