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Nephrectomy for emphysematous pyelonephritis in a nonfunctional renal allograft due to rejection after kidney transplantation

Background Emphysematous pyelonephritis represents an acute and necrotizing infection characterized by the accumulation of gas within the kidney. This condition poses a swift progression toward sepsis, leading to a poor prognosis. We experienced a rare case of emphysematous pyelonephritis in a nonfu...

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Published in:African journal of urology 2024-12, Vol.30 (1), p.30-5
Main Authors: Kikkawa, Kazuro, Wakamiya, Takahito, Kojima, Fumiyoshi, Kohjimoto, Yasuo, Hara, Isao
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Wakamiya, Takahito
Kojima, Fumiyoshi
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Hara, Isao
description Background Emphysematous pyelonephritis represents an acute and necrotizing infection characterized by the accumulation of gas within the kidney. This condition poses a swift progression toward sepsis, leading to a poor prognosis. We experienced a rare case of emphysematous pyelonephritis in a nonfunctioning renal allograft attributed to antibody‐mediated rejection after kidney transplantation. Case presentation A 71-year-old man with diabetes had undergone living-donor renal transplantation from his wife. Unfortunately, the transplanted kidney’s function declined due to antibody-mediated rejection, necessitating the introduction of hemodialysis 12 months post-transplantation. Subsequently, 4 months after initiating hemodialysis, the patient presented with pain and swelling in the right lower abdomen. A computed tomography scan revealed the enlargement of the transplanted kidney and gas formation. This constellation of symptoms led to the diagnosis of emphysematous pyelonephritis, resulting in his hospitalization. Further contrast-enhanced computed tomography scans demonstrated an absence of arterial flow and ischemia within the renal allograft. Despite antibiotic treatment and percutaneous drainage, both the gas and fluid in the renal parenchyma and surrounding tissue displayed minimal reduction. Given these compelling findings, an allograft nephrectomy was performed 20 days into his hospital stay. Pathological examination confirmed complete allograft necrosis, revealing nonviable renal parenchyma. The patient’s postoperative recovery progressed favorably. Conclusions Instances of emphysematous pyelonephritis within transplanted kidneys are infrequently documented. Among these cases, emphysematous pyelonephritis in a nonfunctioning renal allograft is very rare and may be associated with graft ischemia and the presence of injured tissue. The determination of an immediate diagnosis and surgery is important.
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This condition poses a swift progression toward sepsis, leading to a poor prognosis. We experienced a rare case of emphysematous pyelonephritis in a nonfunctioning renal allograft attributed to antibody‐mediated rejection after kidney transplantation. Case presentation A 71-year-old man with diabetes had undergone living-donor renal transplantation from his wife. Unfortunately, the transplanted kidney’s function declined due to antibody-mediated rejection, necessitating the introduction of hemodialysis 12 months post-transplantation. Subsequently, 4 months after initiating hemodialysis, the patient presented with pain and swelling in the right lower abdomen. A computed tomography scan revealed the enlargement of the transplanted kidney and gas formation. This constellation of symptoms led to the diagnosis of emphysematous pyelonephritis, resulting in his hospitalization. Further contrast-enhanced computed tomography scans demonstrated an absence of arterial flow and ischemia within the renal allograft. Despite antibiotic treatment and percutaneous drainage, both the gas and fluid in the renal parenchyma and surrounding tissue displayed minimal reduction. Given these compelling findings, an allograft nephrectomy was performed 20 days into his hospital stay. Pathological examination confirmed complete allograft necrosis, revealing nonviable renal parenchyma. The patient’s postoperative recovery progressed favorably. Conclusions Instances of emphysematous pyelonephritis within transplanted kidneys are infrequently documented. Among these cases, emphysematous pyelonephritis in a nonfunctioning renal allograft is very rare and may be associated with graft ischemia and the presence of injured tissue. 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This condition poses a swift progression toward sepsis, leading to a poor prognosis. We experienced a rare case of emphysematous pyelonephritis in a nonfunctioning renal allograft attributed to antibody‐mediated rejection after kidney transplantation. Case presentation A 71-year-old man with diabetes had undergone living-donor renal transplantation from his wife. Unfortunately, the transplanted kidney’s function declined due to antibody-mediated rejection, necessitating the introduction of hemodialysis 12 months post-transplantation. Subsequently, 4 months after initiating hemodialysis, the patient presented with pain and swelling in the right lower abdomen. A computed tomography scan revealed the enlargement of the transplanted kidney and gas formation. This constellation of symptoms led to the diagnosis of emphysematous pyelonephritis, resulting in his hospitalization. Further contrast-enhanced computed tomography scans demonstrated an absence of arterial flow and ischemia within the renal allograft. Despite antibiotic treatment and percutaneous drainage, both the gas and fluid in the renal parenchyma and surrounding tissue displayed minimal reduction. Given these compelling findings, an allograft nephrectomy was performed 20 days into his hospital stay. Pathological examination confirmed complete allograft necrosis, revealing nonviable renal parenchyma. The patient’s postoperative recovery progressed favorably. Conclusions Instances of emphysematous pyelonephritis within transplanted kidneys are infrequently documented. Among these cases, emphysematous pyelonephritis in a nonfunctioning renal allograft is very rare and may be associated with graft ischemia and the presence of injured tissue. 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arteries</topic><topic>Viral antibodies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kikkawa, Kazuro</creatorcontrib><creatorcontrib>Wakamiya, Takahito</creatorcontrib><creatorcontrib>Kojima, Fumiyoshi</creatorcontrib><creatorcontrib>Kohjimoto, Yasuo</creatorcontrib><creatorcontrib>Hara, Isao</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>African journal of urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kikkawa, Kazuro</au><au>Wakamiya, Takahito</au><au>Kojima, Fumiyoshi</au><au>Kohjimoto, Yasuo</au><au>Hara, Isao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nephrectomy for emphysematous pyelonephritis in a nonfunctional renal allograft due to rejection after kidney transplantation</atitle><jtitle>African journal of urology</jtitle><stitle>Afr J Urol</stitle><date>2024-12-01</date><risdate>2024</risdate><volume>30</volume><issue>1</issue><spage>30</spage><epage>5</epage><pages>30-5</pages><issn>1110-5704</issn><eissn>1961-9987</eissn><abstract>Background Emphysematous pyelonephritis represents an acute and necrotizing infection characterized by the accumulation of gas within the kidney. This condition poses a swift progression toward sepsis, leading to a poor prognosis. We experienced a rare case of emphysematous pyelonephritis in a nonfunctioning renal allograft attributed to antibody‐mediated rejection after kidney transplantation. Case presentation A 71-year-old man with diabetes had undergone living-donor renal transplantation from his wife. Unfortunately, the transplanted kidney’s function declined due to antibody-mediated rejection, necessitating the introduction of hemodialysis 12 months post-transplantation. Subsequently, 4 months after initiating hemodialysis, the patient presented with pain and swelling in the right lower abdomen. A computed tomography scan revealed the enlargement of the transplanted kidney and gas formation. This constellation of symptoms led to the diagnosis of emphysematous pyelonephritis, resulting in his hospitalization. Further contrast-enhanced computed tomography scans demonstrated an absence of arterial flow and ischemia within the renal allograft. Despite antibiotic treatment and percutaneous drainage, both the gas and fluid in the renal parenchyma and surrounding tissue displayed minimal reduction. Given these compelling findings, an allograft nephrectomy was performed 20 days into his hospital stay. Pathological examination confirmed complete allograft necrosis, revealing nonviable renal parenchyma. The patient’s postoperative recovery progressed favorably. Conclusions Instances of emphysematous pyelonephritis within transplanted kidneys are infrequently documented. Among these cases, emphysematous pyelonephritis in a nonfunctioning renal allograft is very rare and may be associated with graft ischemia and the presence of injured tissue. The determination of an immediate diagnosis and surgery is important.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1186/s12301-024-00432-3</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-8001-8264</orcidid><oa>free_for_read</oa></addata></record>
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subjects Abscesses
Antibodies
Antigens
Biopsy
Blood groups
Case report
Case Reports
CT imaging
Diabetes
Diabetics
Donation of organs, tissues, etc
E coli
Emphysematous pyelonephritis
Hemodialysis
Imaging
Infection
Ischemia
Kidney transplantation
Kidney transplants
Kidneys
Medicine
Medicine & Public Health
Nephrectomy
Patients
Pyelonephritis
Radiology
Sepsis
Surgery
Transplantation
Type 2 diabetes
Urinary tract diseases
Urinary tract infections
Urogenital system
Urology
Veins & arteries
Viral antibodies
title Nephrectomy for emphysematous pyelonephritis in a nonfunctional renal allograft due to rejection after kidney transplantation
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