Successful management of bilateral emphysematous pyelonephritis with abscess formation in a chronic hemodialysis patient: a case report

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• 作者：Ryuji Suzuki ; Takehiko Abe ; Hiroji Uchida ; Kazuhiko Niikura
• 关键词：Bilateral emphysematous pyelonephritis ; Conservative antimicrobial therapy ; Hemodialysis ; Abscess
• 刊名：CEN Case Reports
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：4
• 期：1
• 页码：90-94
• 全文大小：894 KB
• 参考文献：1.Aswathaman K, Gopalakrishnan G, Gnanaraj L, Chacko NK, Kekre NS, Devasia A. Emphysematous pyelonephritis: outcome of conservative management. Urology. 2008;71:1007-.View Article PubMed
  2.Tseng CC, Wu JJ, Wang MC, Hor LI, Ko YH, Huang JJ. Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Am J Kidney Dis. 2005;46:432-.View Article PubMed
  3.Kuchay MS, Laway BA, Bhat MA, Mir SA. Medical therapy alone can be sufficient for bilateral emphysematous pyelonephritis: report of a new case and review of previous experiences. Int Urol Nephrol. 2014;46:223-.View Article PubMed
  4.Somani BK, Nabi G, Thorpe P, Hussey J, CooK J, N`Dow J, ABACUS Research Group. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008;179:1844-.View Article PubMed
  5.Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M. Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86:1327-0.PubMed
  6.Vij R, Nataraj S, Peixoto AJ. Diagnostic utility of urinalysis in detecting urinary tract infection in hemodialysis patients. Nephron Clin Pract. 2009;113:281-.View Article
  7.Anwar N, Chawla LS, Lew SQ. Emphysematous pyelitis presenting as an acute abdomen in an end-stage renal disease patient treated with peritoneal dialysis. Am J Kidney Dis. 2002;40:E13.View Article PubMed
  8.Tahir H, Thomas G, Sheerin N, Bettington H, Pattison JM, Goldsmith DJ. Successful medical treatment of acute bilateral emphysematous pyelonephritis. Am J Kidney Dis. 2000;36:1267-0.View Article PubMed
  9.Flores G, Nellen H, Magana F, Calleja J. Acute bilateral emphysematous pyelonephritis successfully managed by medical therapy alone: a case report and review of the literature. BMC Nephrol. 2002;3:1-.View Article
  10.Shigemura K, Yasufuku T, Yamashita M, Arakawa S, Fujisawa M. Bilateral emphysematous pyelonephritis cured by antibiotics alone: a case and literature review. Jpn J Infect Dis. 2009;62:206-.PubMed
  11.Su CY, Lee LC, Lai CH, Wang YH, Yang YK, Ng HY, Lee WC, Tsai YC, Chuang FR, Lee CT. Successful treatment of bilateral emphysematous pyelonephritis in a uremic patient without nephrectomy. Ren Fail. 2009;31:167-0.View Article PubMed
  12.Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis and pathogenesis. Arch Intern Med. 2000;160:797-05.View Article PubMed
  13.Akpek S, Turgut T, Ozdemir H, Ilgit ET, Isik S. Emphysematous pyelonephritis: fatal outcome during percutaneous drainage. Eur J Radiol. 1998;26:287-.View Article PubMed
  14.Ubee SS, Mcglynn L, Fordham M. Emphysematous pyelonephritis. BJU Int. 2010;107:1474-.View Article PubMed
  15.Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology. 1996;198:433-.View Article PubMed
  16.Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk Factors for mortality in patients with emphysematous pyelonephritis: a meta-analysis. J Urol. 2007;178:880-.View Article PubMed
  
• 作者单位：Ryuji Suzuki (1)
  Takehiko Abe (2)
  Hiroji Uchida (3)
  Kazuhiko Niikura (1)
  
  1. Department of Internal Medicine, Hitotsubashi Hospital, 1-2-25 Gakuen Nishimachi, Kodaira-shi, Tokyo, 187-0045, Japan
  2. Department of Radiology, Japan Anti-Tuberculosis Association, Fukujuji Hospital, 3-1-24 Matsuyama, Kiyoshe-shi, Tokyo, 204-8522, Japan
  3. Department of Urology, Hitotsubashi Hospital, 1-2-25 Gakuen Nishimachi, Kodaira-shi, Tokyo, 187-0045, Japan
  
• 刊物主题：Nephrology; Urology/Andrology;
• 出版者：Springer Japan
• ISSN：2192-4449

文摘

Bilateral emphysematous pyelonephritis (EPN) has seldom been reported in patients on maintenance hemodialysis (HD). Percutaneous catheter drainage (PCD) or nephrectomy is often required in the treatment of bilateral EPN because of its poor response to antimicrobial agents and high mortality rate. We report a patient with bilateral EPN on maintenance HD. An octogenarian man with diabetes mellitus who had previously undergone regular HD for 22?months was admitted to our hospital because of severe inflammation resulting from bilateral EPN. His lesions of EPN had resulted in abscess formation in both kidneys and right and left side retroperitoneal space. As patient refused interventional therapy including nephrectomy or PCD, he was treated conservatively. After treatment with several antimicrobial agents for 50?days, he completely recovered from bilateral EPN. To our knowledge, this is the first case report of successful conservative management (antimicrobial therapy alone) of bilateral EPN that developed in a chronic diabetic HD patient.