Conservative Management of Emphysematous Pyelonephritis in Transplantation

Emphysematous pyelonephritis is believed to be one of the most important urologic emergency conditions characterized by an acute and severe necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens. Predisposing risk factors include diabetes, immunosuppression conditions, urinary tract obstruction associated with urinary calculi or papillary necrosis, and significant renal functional damage. The overall mortality rate has been reported to be 19 to 43 percent and few cases in kidney allograft transplantation have been reported. We report a 66-year-old man with diabetes and end-stage renal disease (ESRD) received deceased renal transplant. Two mounts after transplantation, he was admitted in hospital with complain of reduced urine output, increased serum creatinine (Cr) level, fever, and abdominal pain. The patient was treated with 250 mg intravenous imipenem and 1 g intravenous vancomycin per 12 hours; and underwent hemodialysis every other day for one week. An ultrasound-guided percutaneous nephrostomy was accomplished; he considerably responded clinically and radiologically and the transplanted kidney was saved