Emphysematous Pyelonephritis Following Ureterovesical Reimplantation for Congenital Obstructive Megaureter. Pediatric Case Report and Review of the Literature

Abstract

Introduction: Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing infection of the kidney. To date, very few cases of EPN have been described in the pediatric age. The first case of EPN in a toddler occurring after ureterovesical reimplantation for congenital obstructive megaureter is reported with a literature review.Case Report: A 23-month-old male, with a prenatal diagnosis of obstructive megaureter and incomplete duplication of the left urinary tract, was admitted to our Unit where he underwent surgery to treat increased dilatation of the renal pelvis and appearance of an obstructive curve. The latter was revealed at renal scintigraphy, the exam highlighted the radiographic aspect of the cortical renal parenchymal sufferance. At admission preoperative exams were normal, and no recurrent urinary tract infections were documented. Surgical removal of the left stenotic ureteral common tract of the incomplete duplex collecting system was accomplished; ureterovesical reimplantation was performed without ureteral recalibration. No intraoperative complications were recorded. In the immediate postoperative period, urosepsis and the patient's lethargic condition led to life-threatening conditions requiring urgent admission to the intensive care unit. Biochemical analysis showed leukocytosis, anemia, increased C-reactive protein, prolonged prothrombin time, pancytopenia, hyponatremia. Abdominal sonographic evaluation revealed the presence of gas in the left kidney. Unilateral EPN (Class 2) was confirmed by CT- scan. Escherichia coli was cultured from peripheral blood and antimicrobial therapy was started. No additional interventions were required. The child was discharged 14 days postoperatively with normal renal function.Conclusion: EPN is a serious condition that can occur after surgical treatment for urinary tract obstruction. Early detection of air in the kidney should be considered a sign of complicated urinary tract infection. Immediate aggressive resuscitation and antimicrobial therapy are effective and curative with a positive outcome.

Morphometric Parameters of Venous Vessels in Human Kidneys during Aging according to Computed Tomography Data

“…It was found that in all age periods studied by us, the average diameter of the renal vein in males prevailed over that in females, but without a significant difference (Kafarov et al, 2019;Kostilenko and Azmi, 2008;Girgenti et al, 2019).…”

“…Currently, in the scientific literature, there is no unequivocal opinion regarding issues related to the diameters of the renal veins, the knowledge of which is of great clinical importance (Tarabarko, 1995;Shumakov, 2005;Monina, 2014;Russell et al, 2019;Barabanov, 2001;Fulop et al, 2020;Mochalov, 2006;Kafarov et al, 2017;Xu et al, 2021;Jannatbabaei et al, 2019;Jiang et al, 2019;Kafarov et al, 2015;Kvyatkovskaya et al, 2000;Wang et al, 2008;Kafarov et al, 2019;Kostilenko and Azmi, 2008;Girgenti et al, 2019).…”

Case report. Emfysemateuze pyelonefritis bij kinderen

“…Het voorkomen van EPN bij kinderen is echter zeer zeldzaam en is voor het eerst door Pode et al beschreven in 1985 bij een 10-jarige vrouwelijke patiënt [3]. Tot op heden zijn er van EPN bij kinderen acht casus verschenen [3][4][5][6][7][8][9].…”

“…Bij kinderen wordt diabetes niet als risicofactor beschreven. De eerder gepubliceerde casus laten zien dat nefro-urolithiase, gestoorde immuniteit en obstructieve uropathie de voornaamste risicofactoren lijken te zijn [3][4][5][6][7][8][9]. In de hier beschreven casus lijkt een PUJ-stenose op basis van overkruisende vaten de oorzakelijke factor.…”

“…Andere bekende gasvormende uropathogenen zijn Proteus mirabilis, Klebsiella pneumoniae, groep-D-streptokokken en coagulasenegatieve stafylokokken. Zeldzamere verwekkers zijn Clostridium septicum, Candida albicans, Cryptococcus neoformans en Pneumocystis jerovici [9,10].…”