Treatment of Pyonephritis Complicated by Sepsis-Induced Disseminated Intravascular Coagulation Using Recombinant Human Soluble Thrombomodulin and Percutaneous Drainage

Abstract

Pyonephritis is defined as infected hydronephrosis complicated by infectious destruction of the renal parenchyma or the presence of pus in the dilated pyelocaliceal. Pyonephritis is challenging to treat only using antibiotics; it sometimes requires immediate interventional treatment, including surgical intervention, percutaneous drainage, or retrograde ureteric stent insertion, because if left untreated, it may cause sepsis-related disseminated intravascular coagulation (DIC). Here we report three cases of pyonephritis complicated by sepsis-induced DIC using recombinant human soluble thrombomodulin (rhTM) and percutaneous drainage. An 87-year-old female presented with high-grade fever, vomiting, and diarrhea. Non-contrast computed tomography and ultrasonography revealed a dilated ureter and upper ureteral stone in the left kidney. Antibiotic treatment was initiated, and a percutaneous nephrostomy (PCN) tube was inserted into the patient; puncture fluid revealed the presence of Escherichia coli . During treatment, the patient’s DIC score was four points, indicating that rhTM administration was required. A 75-year-old female presented with nausea, diarrhea, and deterioration of consciousness. Laboratory analysis revealed remarkably elevated levels of WBC and CRP, and imaging modalities revealed left-sided hydronephrosis. The patient’s DIC score at admission was six points; rhTM and anti-biotics were administered. A PCN tube was inserted into the patient on the following day. With worsening renal function and oliguria, the patient needed hemodialysis (polymyxin-B direct hemoperfusion and continuous hemodiafiltration). A 62-year-old female presented with high-grade fever and deterioration of consciousness. The patient’s DIC score at admission was four points; rhTM and antibiotics were administered. Imaging modalities showed left-sided hydronephrosis and, the patient required PCN tube insertion. Temporal hemodialysis alleviated the patient’s renal malfunction and septicemia. All three cases recovered from sepsis-related DIC. Immediate and intensive treatments for pyonephritis, including interventional drainage, hemodialysis, administration of antibiotics, and the management of DIC, are necessary to save patients from fatal conditions. World J Nephrol Urol. 2016;5(4):85-90 doi: https://doi.org/10.14740/wjnu283w