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Table of Contents
CORRESPONDENCE
Year : 2019  |  Volume : 8  |  Issue : 3  |  Page : 164-165

Emphysematous pyelonephritis with acute kidney injury in the postpartum period


1 Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication4-Dec-2019

Correspondence Address:
R Ram
Professor, Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCSR.JCSR_68_19

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How to cite this article:
Sangeetha B, Aparna G, Ram R, Lakshmi A Y, Kumar V S. Emphysematous pyelonephritis with acute kidney injury in the postpartum period. J Clin Sci Res 2019;8:164-5

How to cite this URL:
Sangeetha B, Aparna G, Ram R, Lakshmi A Y, Kumar V S. Emphysematous pyelonephritis with acute kidney injury in the postpartum period. J Clin Sci Res [serial online] 2019 [cited 2020 Jan 20];8:164-5. Available from: http://www.jcsr.co.in/text.asp?2019/8/3/164/272298



Emphysematous pyelonephritis (EPN) causing acute kidney injury (AKI) in the postpartum period is rare.[1],[2],[3] We present a patient with unilateral EPN and AKI in the early postpartum period. A 37-year-old, para3 live3, presented in the 1st week of puerperium with high-grade fever, chills and rigors and left loin pain for 2 days. She had no history of dysuria, cloudy urine, haematuria, oliguria, pedal oedema or foul-smelling discharge from vagina. She had no history of pre-eclampsia. She delivered a live full-term male baby by normal vaginal delivery at home. On examination, pulse rate was 124 bpm, blood pressure was 80/60 mm of Hg, temperature was 102°F and pedal oedema was also present. Left lumbar and hypochondrium tenderness and guarding were evident. Investigations revealed serum creatinine of 2.7 mg/dL, haemoglobin of 9.1 g/dL, total leucocyte count of 138,000 per mm3 and platelet count of 94,000 per mm3; ultrasound abdomen revealed the right kidney measuring 10.6 cm × 4.8 cm and left kidney measuring 11.2 cm × 5.2 cm and a hypoechoic lesion with air foci of size 4.6 cm × 2.7 cm also noted in upper pole of the left kidney. Urine and blood cultures grew no organisms. Vaginal swab grew Enterococcus feacalis. Computed tomography (CT) showed Type I[4] and Class 2[5] EPN [Figure 1]. She was treated with injection piperacillin-tazobactam and injection metronidazole. Under CT guidance, percutaneous drainage was established. Pus drained through percutaneous nephrostomy was sterile. She did not require any renal replacement therapy. Fever and renal function improved.
Figure 1: Computed tomographic scan (coronal view) showing enlarged left kidney with pockets of air in the upper pole

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While asymptomatic bacteriuria in non-pregnant women is generally benign, pregnant women with bacteriuria have an increased susceptibility to pyelonephritis. The dilatation of renal pelvis and ureters, displacement of bladder superiorly and anteriorly, mechanical compression by the enlarging uterus, smooth muscle relaxation induced by progesterone, pregnancy-induced glycosuria and aminoaciduria and alterations in the urinary pH and osmolality have been cited as the facilitators for bacterial growth.[6] One of the largest published experiences of EPN was of 48 patients, in whom diabetes mellitus was present in 96% and urinary tract obstruction in 22%.[5] The functional ureteric changes in pregnancy might have been a risk factor in our patient.

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  References Top

1.
Kumar N, Singh NP, Mittal A, Valson AT, Hira HS. An uncommon cause of postpartum renal failure – Bilateral emphysematous pyelonephritis. Ren Fail 2009;31:171-4.  Back to cited text no. 1
    
2.
Ravikumar YS, Srinath KM, Adarsh LS, Shetty MS, Karuturi S, Balaji Kirushnan B. Emphysematous pyelonephritis in a non-diabetic young woman: A rare association. J Indian Acad Clin Med 2012;13:328-9.  Back to cited text no. 2
    
3.
Gaither K, Ardite A, Mason TC. Pregnancy complicated by emphysematous pyonephrosis. J Natl Med Assoc 2005;97:1411-3.  Back to cited text no. 3
    
4.
Wan YL, Lo SK, Bullard MJ, Chang PL, Lee TY. Predictors of outcome in emphysematous pyelonephritis. J Urol 1998;159:369-73.  Back to cited text no. 4
    
5.
Huang JJ, Tseng CC. Emphysematous pyelonephritis: Clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000;160:797-805.  Back to cited text no. 5
    
6.
Schnarr J, Smaill F. Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Eur J Clin Invest 2008;38 Suppl 2:50-7.  Back to cited text no. 6
    


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