Evolving case of emphysematous pyelonephritis in a second renal allograft

Abstract

Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney that portends a poor prognosis. Patients present with sepsis, requiring fluid resuscitation, glucose control, and broad-spectrum antibiotics. Surgical intervention ranges from relief of urinary obstruction (nephrostomy tube or stent), percutaneous drainage or nephrectomy. We present a 51-year-old second kidney transplant recipient diabetic male, suffering from sepsis of unknown etiology which was subsequently revealed to be due to emphysematous pyelonephritis. Percutaneous drainage was performed initially followed by renal transplant nephrectomy after no improvement of his clinical status. Herein, we describe the clinical course and escalation in management.

Nephrectomy for emphysematous pyelonephritis in a nonfunctional renal allograft due to rejection after kidney transplantation

“…EPN in transplanted kidneys is a rare occurrence, with only 43 cases reported in the literature, including our case [4,6,7]. In the previous reports, 80% of the patients had diabetes, and the most frequently isolated organisms from the specimens were Escherichia coli (44%) and Klebsiella pneumoniae (23%).…”

“…Stage 3 necessitates allograft nephrectomy. In the previous reports of EPN in renal allografts, nephrectomy was performed in 21 out of 43 cases (49%) [4,6,7]. Among these 43 cases, 19 (44%) aligned with Al-Geizawi's stage 3 classification, and nephrectomy was performed in 13 out of these 19 cases (68%).…”