Emphysematous Pyelonephritis in a Renal Transplant Patient

Kashif J. Piracha, Frank Darras, Edward P. Nord, Nand K. Wadhwa

Division of Nephrology, Department of Medicine, Stony Brook Medicine, Stony Brook, USA.
Transplantation Services, Stony Brook Medicine, Stony Brook, USA.

DOI: 10.4236/ojneph.2014.42012                

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.

Keywords

Emphysematous Pyelonephritis, Kidney Allograft, Transplant

Conflicts of Interest

The authors declare no conflicts of interest.

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