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

Schmeißer, Alexander; Varughese, Santosh; David, VG; Kodgire, S.V.; Mukha, Rajiv Paul; Kekre, Nitin S; Tamilarasi, V.; Jacob, C. K.; John, George T.

doi:10.1111/tid.12016

Cited by 15 publications

(15 citation statements)

References 25 publications

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“…Advances in culture techniques have helped in timely management of septic patients with sensitive antibiotics. Thus, potentially life threatening / graft threatening complications can effectively be managed with aggressive non-surgical measures [7].…”

Section: Urinary Tract Infectionsmentioning

confidence: 99%

Infections After Kidney Transplantation: The Bug Bear Of Kidney Transplantation In Tropics

Basu¹

2015

TOUNJ

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Abstract:Infections are the bugbear of kidney transplantation in the tropics, being responsible for majority of the deaths. Despite the several challenges posed by infections in kidney transplant recipient in the tropics, various developments have resulted in a decline in the rate of infections as well as their consequences. This review aims to be a basic overview of the common infections in KTR with an attempt to provide a unique tropical country perspective.

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Section: Urinary Tract Infectionsmentioning

confidence: 99%

Infections After Kidney Transplantation: The Bug Bear Of Kidney Transplantation In Tropics

Basu¹

2015

TOUNJ

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“…Hemos constatado bacteriemia en 25 (12%) de los 215 episodios de ITU, porcentaje disminuido comparado con otras series (18% a 39%) (3,5,16,27) . Señalamos un manejo exitoso de pielonefritis aguda enfisematosa por Klebsiella pneumoniae, mediante drenaje percutáneo de la colección purulenta realizado por el radió-logo intervencionista (3,24,38) . La pielonefritis aguda es causa también de disfunción del injerto renal (39) .…”

Section: Discussionunclassified

Infección del tracto urinario en receptores de trasplante renal

et al. 2017

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Introducción. La infección del tracto urinario (ITU) es común en receptores de trasplante renal (TR). La frecuencia de ITU depende de factores previos y posteriores al trasplante. Objetivos. Determinar la cronología de aparición de ITU sintomática, los microorganismos causantes y la incidencia de ITU resistente a antibióticos en receptores de TR. Diseño. Estudio retrospectivo. Lugar. Unidad de Trasplante Renal, Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Participantes. Pacientes sometidos a TR. Intervenciones. Se revisó la historia clínica de 304 pacientes sometidos a TR en el período 2002-2011, con seguimiento de hasta cuatro años por paciente. Se constató 215 episodios de ITU sintomática confirmada mediante urocultivo en 84 receptores. Principales medidas de resultados. Incidencia, cronología, determinación microbiológica/ susceptibilidad, resistencia bacteriana, factores de riesgo, estrategias diagnósticas, presencia o no de bacteriemia y manejo terapéutico. Resultados. En 50% de los 84 receptores el episodio inicial ocurrió durante los primeros tres meses, y en 39% se constató más de un episodio de ITU. Las bacterias representaron la etiología más frecuente (94%), siendo la Escherichia coli (77%) el uropatógeno prevalente, con tasa productora betalactamasa espectro extendido (BLEE) en 38%, seguida de Klebsiella pneumonie (11%) con BLEE 65%. En 12% de los 215 episodios de ITU el hemocultivo fue positivo. Entre los factores de riesgo se detectó luego del trasplante 19% receptores con anormalidades anatómicas del tracto urinario. Conclusiones. La ITU ocurrió tempranamente luego del trasplante y la Escherichia coli fue el microorganismo etiológico más frecuente. La resistencia antibiótica estuvo presente en 37% de los 215 episodios de ITU, representando un desafío contínuo a resolver en la práctica clínica.

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“…Post-operatively, the patient rapidly recovered and was subsequently discharged home on chronic maintenance hemodialysis. Emphysematous pyelonephritis (EPN) is an acute necrotizing bacterial or fungal infection of the kidney associated with the presence of gas within the renal parenchyma, collecting system or perinephric tissue [1]. While EPN is well described in the native kidney, to the best of our knowledge, only 20 cases have been reported in the transplanted kidney.…”

Section: Discussionmentioning

confidence: 99%

“…Since gram negative bacilli account for the overwhelming number of infections ( Table 1), initial empiric antibiotic coverage should take this observation into account. If hemodynamic stability can be attained, percutaneous catheter drainage of the renal pelvis should be undertaken [1] [7]. However, in the setting of multi-organ failure and uncontrolled sepsis, early transplant nephrectomy should be the approach of choice [3] [8].…”

Section: Discussionmentioning

confidence: 99%

“…Emphysematous pyelonephritis (EPN) in the transplanted kidney is a rare, severe, often life-threatening condition that is characterized by acute necrotizing infection involving the renal parenchyma and surrounding tissues, caused by gas-forming organisms [1]. Risk factors include diabetes mellitus and urinary tract obstruction caused by calculi, tumors, and strictures [2].…”

Section: Introductionmentioning

confidence: 99%

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Emphysematous Pyelonephritis in a Renal Transplant Patient

Piracha¹,

Darras²,

Nord³

et al. 2014

OJNeph

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Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection of the kidney that is caused by gas-forming organisms. We report a case of a 58-year-old man with a renal transplant who presented to the emergency room with nausea, vomiting and right lower quadrant abdominal pain. At the time of presentation, he was hemodynamically stable, and the abdominal examination was significant for tenderness over the allograft. Urinalysis was positive for large amounts of leukocyte esterase and white blood cells. He received empiric antibiotic coverage with piperacillin/tazobactam. Over the following 24 hours, the patient developed septic shock manifested by hemodynamic instability. A non-contrast CT scan of the abdomen and pelvis elucidated a heterogeneous gas containing collection in the allograft. Emergent transplant nephrectomy was performed. Postoperatively, the patient rapidly recovered and was subsequently discharged home to commence outpatient hemodialysis. A review of the literature suggests that early recognition of the severity of EPN as manifested by hemodynamic instability dictates emergent transplant nephrectomy as the treatment of choice.

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

Cited by 15 publications

References 25 publications

Infections After Kidney Transplantation: The Bug Bear Of Kidney Transplantation In Tropics

Infections After Kidney Transplantation: The Bug Bear Of Kidney Transplantation In Tropics

Infección del tracto urinario en receptores de trasplante renal

Emphysematous Pyelonephritis in a Renal Transplant Patient

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