11/165. Bilateral emphysematous pyelonephritis with perirenal abscess cured by conservative therapy.Emphysematous pyelonephritis is a rare life-threatening infection of the renal parenchyma. It usually affects unilateral kidney and occurs mostly in diabetic patients. It is characterized by the presence of gas within the renal parenchyma and requires prompt diagnosis and early aggressive therapy. Bilateral emphysematous pyelonephritis is even more rare and is associated with high mortality. We describe a case of a 62-year-old diabetic woman who presented with nonketotic hyperosmolar coma and bilateral emphysematous pyelonephritis caused by klebsiella pneumoniae. diagnosis of bilateral emphysematous pyelonephritis was confirmed by an abdominal computed tomographic scan and microbiologic studies. Our patient was successfully treated using percutaneous catheter drainage and long-term antibiotic therapy.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/165. Emphysematous pyelonephritis.Emphysematous pyelonephritis is a rare, severe, necrotizing form of renal infection characterized by the presence of gas within the renal parenchyma or perinephric space. In patients suspected of emphysematous pyelonephritis, computed tomography scan should be done promptly. Based on the available data and this case, surgical intervention appears to be the preferred treatment.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
13/165. Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients.STUDY DESIGN: A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms. OBJECTIVES: To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients. SETTING: Regional spinal injuries Centre, Southport, UK. methods: A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis. RESULTS: A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of flank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous inflammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi. CONCLUSIONS: The symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysreflexia. physicians should be aware of the serious import of these symptoms in SCI patients.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
14/165. Adrenal lymphangioma: a case report.We present a case of a 30-year-old female who was evaluated for right flank pain. Clinical and diagnostic work up revealed a urinary tract infection with focal pyelonephritis of the right kidney. Ultrasound and computed tomography of the abdomen were included in the evaluation and revealed incidental finding of cystic structure at right suprarenal space. Follow-up evaluation for further characterization of cyst was performed with MRI and displayed a 4.8x4.5-cm right adrenal cyst containing dystrophic calcification, septations, and minimal nodularity. Surgical resection and histologic findings were compatible with cystic lymphangioma of the adrenal gland. Adrenal lymphangioma is a rare and benign lesion that is most often identified incidentally during radiological investigation or at autopsy. Diagnostic features of adrenal cysts including lymphangiomas are discussed.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
15/165. peptostreptococcus asaccharolyticus renal abscess: a rare cause of fever of unknown origin.Renal abscess is uncommon in pediatrics and is rarely a cause of fever of unknown origin. We recently cared for a patient who presented with a 3-week history of fever. An indium scan ultimately led to the diagnosis of a renal abscess. Aspiration yielded peptostreptococcus asaccharolyticus. This unusual case prompted a review of the clinical and microbiologic features of renal abscess in pediatric patients at our hospital over the past 10 years. Seven additional patients with a discharge diagnosis of renal abscess were identified. Only 2 of the patients had identifiable risk factors (diabetes mellitus and polycystic kidneys). staphylococcus aureus or enterobacteriaceae were responsible for most infections, consistent with hematogenous and urinary tract sources, respectively. No other cases of anaerobic abscess were identified. This case highlights the importance of considering a renal abscess in the differential diagnosis of fever of unknown origin and of processing specimens for both aerobic and anaerobic organisms.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
16/165. endotoxemia causing fetal bradycardia during urosepsis.BACKGROUND: Fetal bradycardia is a recognized response to maternal hypothermia associated with hypoglycemia, tocolysis with magnesium sulfate, or urosepsis, and it is thought to be a direct response to the decrease in the maternal core temperature. CASE: A 25-year-old white woman, gravida 1, para 0, at 31 1/7 weeks' gestation was admitted with a diagnosis of pyelonephritis. The baseline fetal heart rate was 120 beats per minute with accelerations. Within 3 hours of admission, the patient became hypothermic (35.1C) and, concomitantly, the fetal heart rate baseline declined to 90 beats per minute with marked variability. Despite sustained maternal hypothermia, the fetal heart rate baseline rose to 120 beats per minute. It was another 6 hours before the patient's temperature rose above 38.5C. Her urine and blood cultures were positive for serratia rubidacea infection. The patient delivered a healthy infant at 39 weeks' gestation. CONCLUSION: Fetal bradycardia in the presence of urosepsis might be due to the release of endotoxin from gram-negative bacteria, triggering production of cardiotoxic cytokines, rather than to maternal hypothermia alone.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
17/165. Emphysematous urinoma in a renal transplant patient.Urinary infection is a common complication after kidney transplantation. In some instances, especially with escherichia coli infections, there is formation and collection of gas in the parenchyma and collecting system of the kidney, giving rise to the condition of emphysematous pyelonephritis. Such a process could occur in collections of urine (urinoma) secondary to ureteric leak in the transplant kidney. This process has not been described so far. In this report, we describe the first case of an infected urinoma with an interesting radiologic finding, a so-called emphysematous urinoma.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
18/165. Gas-containing renal stones treated with percutaneous nephrolithotomy: case report.We present a rare case of E. coli emphysematous pyelonephritis with sepsis. The radiologic presentation consisted of multiple radiolucent gas-filled, free-floating uric acid calculi in a hydronephrotic renal pelvis. The infection was treated by intravenous fluids and antibiotics and percutaneous nephrostomy drainage. The patient was rendered stone free by percutaneous nephrolithotomy and ultrasound lithotripsy.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
19/165. Endotoxinaemia and the pathogenesis of acute renal failure.A study has been made by Limulus assay of the incidence of endotoxinaemia in renal disease: positive results were found in 12/16 patients at the onset of acute renal failure. Results are supported by those of a platelet nitroblue tetrazolium reduction assay. In individual cases increased fibrinogen catabolism has been linked to substantial endotoxin levels. The assay can evaluate endotoxinaemia as a cause of acute renal failure and also detect secondary infection. Shwartzman equivalents appear to account for most cases of acute renal failure in man.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
20/165. Unpredicted spontaneous extrusion of a renal calculus in an adult male with spina bifida and paraplegia: report of a misdiagnosis. Measures to be taken to reduce urological errors in spinal cord injury patients.BACKGROUND: A delay in diagnosis or a misdiagnosis may occur in patients with spinal cord injury (SCI) or spinal bifida as typical symptoms of a clinical condition may be absent because of their neurological impairment. CASE PRESENTATION: A 29-year old male, who was born with spina bifida and hydrocephalus, became unwell and developed a swelling and large red mark in his left loin eighteen months ago. pyonephrosis or perinephric abscess was suspected. X-ray of the abdomen showed left-sided staghorn calculus. Since ultrasound scan showed no features of pyonephrosis or perinephric abscess, he was prescribed a prolonged course of antibiotics for infection presumed to arise from the site of metal implant in spine. He developed a discharging sinus, following which the loin swelling and red mark subsided. About three months ago, he again developed a red mark and minimal swelling in the left loin. Ultrasound scan detected no abnormality in the renal or perinephric region. Therefore, the red mark and swelling were attributed to pressure from the backrest of his chair. Five weeks later, the swelling in the left loin burst open and a large stone was extruded spontaneously. An X-ray of the abdomen showed that he had extruded the central portion of the staghorn calculus from left kidney. With hindsight, the extruded renal calculus could be seen lying in the subcutaneous tissue of left loin lateral to the 10th rib in the X-ray of abdomen, which was taken when he presented with red mark and minimal swelling. CONCLUSION: This case illustrates how mistakes in diagnosis could occur in spinal cord injury patients, and highlights the need for corrective measures to reduce urological errors in these patients. Voluntary reporting of urological errors is recommended to facilitate learning from our mistakes. In the patients who have marked spinal curvature, ultrasonography of kidneys and perinephric region may not be entirely reliable. As clinical symptoms and signs may be non-specific in SCI patients, they require prompt, detailed and occasionally, repeated investigations. A joint team approach by health professionals belonging to various medical disciplines, which is strengthened by frequent, informal and honest discussions of a patient's clinical condition, is likely to reduce urological errors in SCI patients.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
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