Bilateral acute non-obstructive pyelonephritis presenting as acute kidney injury requiring haemodialysis

Abstract

A 54-year-old female patient with hypothyroidism and diabetes mellitus type 2 was brought to emergency room by the family members for acute change in mental status. The laboratory evaluation demonstrated findings consistent with acute renal failure (normal renal function 3 months prior to presentation). She was initiated on hemodialysis due to lack of improvement in renal function. Urine culture done prior to initiation of antibiotics was positive for Escherichia coli, which was later confirmed by renal biopsy. Extensive workup for the cause of renal failure including for connective tissue disease, plasmacytoma, obstruction was negative. She was treated with 6 week course of antibiotics with eventual recovery of her renal function in 4 months.

Acute Non-Obstructive Bilateral Pyelonephritis With Acute Kidney Injury Requiring Hemodialysis

“…Prompt management of pyelonephritis, specifically among immunocompromised patients, is essential to prevent shock and permanent damage to the kidneys. Acute bilateral nonobstructive pyelonephritis among diabetic patients has been previously reported [2,3]. Here, we present a rare case of acute non-obstructive bilateral pyelonephritis with acute renal failure in a patient with HIV requiring hemodialysis.…”

“…Acute kidney injury is defined as an acute decline in kidney function due to an insult or injury resulting in a loss of renal function [3]. Acute kidney injury can be further classified as either prerenal, intrarenal, or postrenal [4].…”

“…Common complications of pyelonephritis can include the formation of a renal abscess, permanent parenchymal destruction that can lead to scarring, and a significant and potentially permanent loss or reduction in renal function [3]. The diagnosis of pyelonephritis involves performing a urinalysis with a subsequent urine culture.…”

“…While the incidence of bilateral non-obstructive pyelonephritis is rare, studies have shown that the risk of developing acute kidney injury is greater in those with bilateral renal involvement compared to unilateral pyelonephritis [3,4,10]. Clinically, unilateral and bilateral pyelonephritis present similarly with systemic symptoms including nausea, fever, increased urinary frequency and urgency, and flank pain.…”

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

“…The characteristics of adult cases with severe AKI caused by APN without urinary tract obstruction, single kidney, or chronic kidney disease (CKD), that were reported in the relevant English literature from 1969 to 2019 are shown in Table ( 6 - 24 ). Severe AKI was defined as KDIGO stage 2 or 3.…”