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Results for “Pyonephrosis”

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PubMed2002

[Radiologic and gammagraphic findings in a case of pyonephrosis. Anatomopathologic correlation].

OBJECTIVE: To describe a case of pyonephrosis in a child with special reference to the importance of scintigraphy in its evaluation. METHODS: We studied the correlation of the findings of conventional radiology (abdominal x-ray), ultrasound, abdominal CT, scintigraphy and anatomopathology (left kidney) in a 5-year-old boy with a history of renal lithiasis that was seen at our pediatric emergency services. The patient's clinical course and the scinscan findings using two tracers (Tc-99m DMSA, Ga-67 citrate) showed a severely compromised left renal function. The foregoing finding and the risk of major life-threatening complications prompted surgical treatment. Pathological analysis showed pyonephrosis of left kidney. RESULTS: X-ray, ultrasound and abdominal CT showed left renal lithiasis, an enlarged left kidney, poor cortico-medullary differentiation and parenchymal destructuring with areas suggestive of cortical abscesses. A Ga-67 citrate scintiscan showed a notable intensity that completely affected the left renal parenchyma with no other changes. On the other hand, Tc-99m DMSA showed no uptake in the left kidney and normal uptake in the right kidney. A left nephrectomy was performed. Histological analysis demonstrated pyonephrosis of left kidney. CONCLUSIONS: Tc-99m DMSA and Ga-67 citrate scintigraphy and the patient's poor clinical course showed the extent and severity of the underlying condition that was underestimated by the other imaging techniques.

Child, Preschool↗

PubMed2004

[A case report of splenic abscesses due to pyonephrosis].

We report a rare case of splenic abscesses that were derived from left pyonephrosis. A 58-year-old woman was referred to our hospital with complaints of fever and epigastralgia. Computed tomography revealed splenic abscesses and left pyonephrosis with staghorn calculi. After admission, her condition improved with conservative therapy. Eight months later, the splenic abscesses had disappeared. The patient was then readmitted and left nephrectomy was performed to prevent relapse of the splenic abscesses. We suspected that direct invasion of inflammation from the left pyonephrosis caused the splenic abscesses, as her left kidney had adhered to the spleen. Only one case of splenic abscesses derived from a urinary tract infection has been reported in Japan.

Female↗

PubMed1993

Computed tomography of pyonephrosis.

Computed tomographic (CT) findings of 17 pyonephrotic and 20 uninfected hydronephrotic kidneys were reviewed. Parameters evaluated included: renal pelvic wall thickness (none; grade 1, < or = 2 mm; grade 2, 3-5 mm; and grade 3, > 5 mm), renal pelvic contents, parenchymal, and perirenal findings. All patients underwent subsequent percutaneous nephrostomy within 1 week of CT. Common CT findings suggesting pyonephrosis include increased pelvic wall thickness and more severe perirenal fat changes than are seen in uninfected hydronephrosis. However, for any one patient, these findings are often not diagnostic. The presence of clinical signs of infection with hydronephrosis on CT is a more sensitive indicator of pyonephrosis than most CT findings.

Adult↗

PubMed1985

Pyocystis, pyonephrosis and perinephric abscess in end stage renal disease.

We report 8 patients with end stage renal disease on maintenance hemodialysis who had pyocystis, pyonephrosis or a perinephric abscess. Delay in diagnosis was frequent because the urine-deprived bladder and kidneys were dismissed as potential sites of infection. Treatment of pyocystis with bladder irrigations often was successful and obviated cystectomy. Pyonephrosis or perinephric abscess was a more serious problem and required unilateral nephrectomy.

Abscess↗

PubMed2002

Outcome of percutaneous nephrostomy for the management of pyonephrosis.

OBJECTIVE: The aim of this study was to evaluate the efficacy of percutaneous nephrostomy (PCN) drainage for the interim management of pyonephrosis. METHODS: Ninety-two consecutive patients [29 men, 63 women; mean age, 57 years; range, 23 to 88] who underwent PCN for the treatment of pyonephrosis from 1996 to 1999 were evaluated retrospectively. The clinical presentation, bacteriology and patient outcomes were analyzed. RESULTS: The majority [77%] of patients had underlying obstructing urinary calculi. Other causes of obstruction included strictures [9%], papillary necrosis [7%], pelvi-ureteric junction obstruction [4%] and malignant stricture [3%]. The microorganisms cultured were Escherichia coli [30%], Klebsiella [19%], Proteus [8%], Pseudomonas [5%], Enterococcus [5%], and Candida spp [5%]. The microorganisms were sensitive to gentamicin [79%], ceftriaxone [71%], cephalexin [54%], nitrofurantoin [40%], cotrimoxazole [35%], nalidixic acid [32%] and ampicillin [29%]. Only 30% of bladder urine cultures were positive for microorganisms; the addition of PCN cultures improved this yield to 58%. The antibiotic regimen was revised according to the PCN culture whenever there was a discrepancy. After PCN, 69% of patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion. Only 14% of patients required open surgery. There was low procedure-related morbidity [14%] and low overall mortality [2%]. CONCLUSIONS: PCN cultures yield important bacteriological information. The procedure is associated with minimal morbidity, facilitates definitive treatment and provides therapeutic benefit.

Adult↗

PubMed2002

Multiple endocrine neoplasia type 1 with pyonephrosis.

A case of multiple endocrine neoplasia type 1 (MEN 1) with a clinical manifestation of pyonephrosis is reported. A 47-year-old woman with a 14-year history of renal stones was initially seen with pyonephrosis. The patient was found to have elevated serum levels of parathyroid hormone and growth hormone. Radiologic examinations demonstrated an ectopic parathyroid tumor and a pituitary tumor. She was diagnosed as having MEN 1.

Diagnosis, Differential↗

PubMed1982

Pyonephrosis: a critical review of 131 cases.

One hundred and thirty-one patients operated on for pyonephrosis within a 4-year period are reviewed. Male to female ratio was 1:2 and urolithiasis was the most common aetiological factor (70.2%). Primary nephrectomy proved to be a very satisfactory mode of treatment. Preliminary nephrostomy no longer appears necessary other than in exceptional circumstances. In a selected group of patients with pyonephrosis following acute obstruction of the kidney by a stone, successful management was achieved by prompt relief of the obstruction.

Adolescent↗

PubMed1991

Pyonephrosis and renal abscess associated with kidney tumours.

Whilst the diagnosis of pyonephrosis and renal abscess is fairly easy, the source of obstruction and infection is an important indicator of treatment. The association of kidney tumours with these inflammatory manifestations has not previously been emphasised. Reviewing our cases of pyonephrosis and renal abscesses, we report 4 patients with concomitant tumours of the kidney and discuss their management.

Abscess↗

PubMed1986

Unilateral pyonephrosis with septic thrombosis of the renal vein and vena cava.

A case of unilateral abscess-forming pyonephrosis with thrombosis of the renal vein and of the adjacent wall of the vena cava will be presented. This septic thrombosis as a consequence of an antecedent septicemia appears to be a late complication of pyonephrosis. In the differential diagnosis renal carcinoma could not be excluded whether pre- nor intraoperatively.

Humans↗

PubMed2003

Lower moiety pelvic-ureteric junction obstruction (PUJO) of the duplex kidney presenting with pyonephrosis in adults.

The most common congenital abnormality of the urinary tract is a duplex kidney. Pelvic-ureteric junction obstruction (PUJO) is a rare association that can affect the lower moiety of incomplete duplex kidneys. We report two adult cases of PUJO of the lower moiety in a duplex kidney that both presented with pyonephrosis. This late presentation of lower moiety PUJO with pyonephrosis has not been described previously. We describe the imaging appearances of this rare association and highlight this important diagnostic consideration in lower moiety hydronephrosis of the adult patient.

Adolescent↗

PubMed2003

[Intractable duodenocutaneous fistula after nephrectomy for stone pyonephrosis: report of a case].

A 56-year-old woman was admitted to our hospital for treatment of right stone pyonephrosis with a perirenal abscess. After right nephrectomy for the pyonephrosis, the patient suffered from post-operative bleeding, which was stopped by closing off the drain tube with a clamp. However, a right retroperitoneal abscess with gas formation developed nine days after the operation, necessitating an operative procedure for drainage. Pus culture revealed Staphylococcus epidermidis and Candida albicans. Discharge from the drain tube became dark green days after the drainage procedure. Upper gastrointestinal series revealed a duodenal fistula, which could not be closed using a retroperitoneal approach, so the operative wound was left open. Because of the volume of discharge (800-1,400 ml/day), somatostatin analogue, 100 micrograms, was injected subcutaneously twice a day. Discharge decreased by one-half within 2 weeks of the administration of somatostatin analogue. However, the duodenocutaneous fistula had not resolved over a period of 8 months. Since the patient developed acute cholecystitis, both cholecystectomy and closure of the duodenocutaneous fistula were performed transperitoneally. The duodenocutaneous fistula, which was closed with Endo GIA (35 mm), had protruded from a descending portion of the duodenum like the diverticulum. The postoperative course was uneventful. We speculated that the fistula occurred as a result of the inflammation with the abscess formation.

Cutaneous Fistula↗

PubMed2004

[A case of pyonephrosis caused by a protein calculus in a patient on hemodialysis].

We report a case of pyonephrosis caused by a protein calculus in a patient on hemodialysis. A 56-year-old man had been treated with dialysis for five years because of end-stage renal failure. The patient complained of right lumbar back pain and fever. Computed tomography and an ultrasonography revealed right hydronephrosis. Pyonephrosis was strongly suspected. A single-J catheter was indwelt, cloudy pus with a terrible smell was discharged. After reducing inflammation, a right nephrectomy was performed. The analysis of stone component revealed mostly a protein calculus, which was a black and turf-like substance in the calices. Patients undergoing dialysis often develop urinary calculi. Some calculi are composed of beta2-microglobulin-origin amyloid, which is very difficult to find with diagnostic imaging.

Amyloid↗

PubMed2005

[Clinical case of the month. Peritonitis after spontaneous rupture of pyonephrosis. A case report].

Peritonitis after spontaneous rupture of pyonephrosis is a rare complication, usually diagnosed intraoperatively. We report the case of a 35 year old woman who was admited for an acute abdomen. Ultrasound showed features of acute peritonitis, with left pyonephrosis, confirmed by a CT-SCAN. Treatment consisted of laparotomy with nephrectomy and abdominal washing and draining. The outcome was favourable.

Acute Disease↗

PubMed2004

Chronic pyonephrosis associated with renal neovascularisation.

The spectrum of renal tract infections is wide. When the kidney has been severely damaged, the radiological findings may suggest a malignancy. To report a case of chronic pyonephrosis, which even at exploration appeared to be a malignancy. The case record of the patient as well as the literature were reviewed and reported. A 25 year-old woman presented with a 5-year history of left lumbar pain, urinary frequency and intermittent total haematuria. The intravenous urography showed non-function in the left kidney harbouring a calculus. Treatment was delayed for poor finances. At laparotomy a huge renal mass invading the colonic mesentery and showing neovascularisation was removed. The final diagnosis was chronic pyonephrosis. She recovered from postoperative septicaemia. Neovascularisation is a feature of malignant disease mediated by angiogenesis factors. These factors are probably present in chronic inflammation. It is suggested that for nephrectomy, prophylactic antibiotics should be used. There is also a need for histopathological examination of every specimen removed at operation.

Adult↗

PubMed2005

Pregnancy complicated by emphysematous pyonephrosis.

Emphysematous pyonephrosis is a rare, rapidly progressive infection characterized by the presence of exudative material and fermentative gases within a dilated renal collecting system. This unusual clinical entity is noted almost exclusively in diabetic patients, often in conjunction with chronic urinary tract infection and obstruction. In most instances, E. coli is the etiologic agent; however other enterobacteriaceae may be isolated. High fever, leukocytosis, renal parenchymal necrosis and the accumulation of gases in the kidney and perinephric tissues are the hallmark of this condition. Surgical resection of the involved tissue and systemic antibiotic administration are among the primary mainstays of therapy. We present a unique case of a pregnant patient with fulminant emphysematous pyonephrosis and the successful treatment rendered.

Adult↗

PubMed1978

[Gluteal fistula that developed spontaneously from pyonephrosis].

A case is described in which pyonephrosis of 21 months standing has caused gluteal fistula by spontaneously breaking through the deep dorsal musculature. Though the patient has been hospitalized in the surgical ward and treated as out-patient in the specialized surgery for gluteal abscess, i.e. fistula, pyonephrosis maintaining of the fistula was detected and treated only after 18 months. After nephrectomy the fistula closed spontaneously and the patient was cured when leaving the hospital.

Abscess↗

PubMed1993

[Initial treatment of pyonephrosis using percutaneous nephrostomy. Value of the technique].

Until early in the eighties, the initial treatment of choice for pyonephrosis was by emergency surgical excision, which carried a high intraoperative and early postoperative morbidity and mortality. The introduction of percutaneous nephrostomy, a technique with a low complication rate that permits easy access in dilated excretory tracts and is highly effective, as shown by the clinical and analytical course of the patients with pyonephrotic kidney and by the number of nephrectomies performed, represented a substantial change in the initial therapeutic approach. The present article reports our experience of 123 percutaneous nephrostomies performed in 118 pyonephrotic kidneys over a period of 10 years, which constitutes one of the largest series reported in the literature. The clinical features and the findings disclosed by imaging techniques that permit making the diagnosis are presented. We describe the PCN procedure and its advantages, with special reference to the reduced morbidity and mortality, particularly in those cases complicated by septic shock. The procedure also permits evaluation of the underlying obstructive uropathy and function of the compromised kidney, therefore more renal units can be preserved, nephrectomy can be avoided and morbidity is minimal. For all the foregoing reasons, PCN guided by an imaging technique is currently the most effective initial treatment of pyonephrosis.

Adolescent↗

PubMed1981

Fast Diagnosis (6h) of clinically silent pyonephrosis by combined use of 99mTc-MDP and 67Ga citrate.

A fast diagnosis (6h) of clinically latent pyonephrosis by combined use of 99mTc-MDP and 67Ga-citrate is reported. This technique combines the potential early detection of focal infectious processes by 67Ga and the "high-pulse" separation possibility of multiple isotopes. A brief prospective study (6 months) showed the interest of this technique: in six cases focal bone and/or joint infections were found three of which were absolutely latent clinically.

Adult↗