Emphysema in the renal allograft.

Potter, Janet L.; Sullivan, Barbara M.; Flournoy, James G.; Gerza, C.

doi:10.1148/radiology.155.1.3883423

Cited by 24 publications

(13 citation statements)

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“…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%

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

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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.

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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

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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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“…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

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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.

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Emphysema in the renal allograft.

Cited by 24 publications

References 0 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

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

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

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