TITLE:
Emphysematous Pyelonephritis in a Renal Transplant Patient
AUTHORS:
Kashif J. Piracha, Frank Darras, Edward P. Nord, Nand K. Wadhwa
KEYWORDS:
Emphysematous Pyelonephritis, Kidney Allograft, Transplant
JOURNAL NAME:
Open Journal of Nephrology,
Vol.4 No.2,
June
11,
2014
ABSTRACT: 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.