Sepsis due to pyonephrosis: an adult with pelvic–ureteric junction obstruction (PUJO) in a duplex kidney

Abstract

We present the case of a 75-year-old woman with sepsis. She was evaluated with bedside ultrasound with a diagnosis of pyonephrosis, and subsequently underwent a TC scan that showed a pelvic-ureteric junction obstruction (PUJO) in a duplicated renal system. PUJO associated with duplex kidney, while relatively frequent in children, is a rare condition in adults, and may lead to severe complications as in this case.Keywords Ultrasound Á Sepsis Á Pyonephrosis Á Duplex kidney Á PUJO Riassunto Presentiamo il caso di una donna di 75 anni affetta da sepsi. E' stata valutata con ecografia al letto del malato con una diagnosi di pionefrosi, successivamente è stata sottoposta a TC che ha dimostrato una ostruzione del giunto pielo ureterale (PUJO) in un sistema renale duplicato. PUJO associata a doppio distretto, relativamente frequente nel bambino, è un condizione rara nell'adulto, a può condurre a complicazioni severe come in questo caso.

An unusual case: Adult giant pyonephrosis

“…In children, urinary obstruction is mostly associated with UPJO. But Simoni et al [5] presented an extraordinary case of UPJO associated with duplex kidney in a 75-year-old woman. On the other hand, in adults, urinary tract stones are the main cause of urinary obstruction [6].…”

Usefulness of Ultrasound to Help Solve Severe Sepsis

“…Evaluation of the genitourinary system by ultrasonography has been described in the diagnostic workup of septic patients. 5,6 When hydronephrosis is identified, ultrasonography of the bladder should be performed to rule out bladder outlet obstruction. Classically, outflow tract obstruction causes bilateral hydronephrosis; however, in its early stages the hydronephrosis can be asymmetric.…”