Emergency Nephrectomy Research Articles

Bilateral emphysematous pyelonephritis

In any diabetic patient being diagnosed or treated for pyelonephritis, it is important to exclude the diagnosis of emphysematous pyelonephritis, which carries a high mortality rate. The authors present an illustrative case of emphysematous pyelonephritis treated with antibiotics and emergency nephrectomy. The signs, symptoms, pathophysiology, diagnosis, and treatment of emphysematous pyelonephritis are discussed.

Emphysematous pyelonephritis in diabetic patients

To determine the clinico-pathological profile of patients with emphysematous pyelonephritis (EPN). The records of 22 diabetic patients who presented with EPN were reviewed. EPN occurred predominantly in female diabetic patients without evidence of ureteric obstruction. The ages of the patients and the duration of the diabetes were variable. EPN occurred in insulin-dependent as well as non-insulin-dependent patients. The patients presented following a prodromal illness of urinary sepsis, with an acute severe illness with symptoms and signs on the affected side. Dehydration and ketoacidosis were common. The diagnosis was made by recognizing gas in the kidney on an X-ray or ultrasound. Eighteen patients were subjected to emergency nephrectomy. EPN is an uncommon, life-threatening condition characterized by the production of intraparenchymal gas. We believe that vigorous resuscitation and emergency nephrectomy is the treatment of choice.

Rottura spontanea acuta di angiomiolipoma in rene unico chirurgico

The Authors report a case of angiomyolipoma in sole surgical kidney (preceding right nephrectomy for neoplasia with re-examined diagnosis) in acute spontaneous rupture. Emergency nephrectomy has led to discussion about conservative surgery in cases of angiomyolipoma over 4 cm.

Renal peripelvic lymphangiectasia: appearance at CT.

In a patient who had undergone emergency nephrectomy during exploratory surgery, a pathologic diagnosis of peripelvic lymphangiectasia was made. Subsequent computed tomographic examination of the remaining kidney showed large multilocular renal sinus cysts, renal capsular cysts, and regions of fluid attenuation surrounding the mesenteric vessels, findings consistent with peripelvic lymphangiectasia. A brief discussion of cystic disease of the renal sinus is presented.

Percutaneous Decompression: Treatment for Respiratory Distress Secondary to Multicystic Dysplastic Kidney

Multicystic dysplastic kidney is a common renal anomaly in the newborn. Long-term problems, such as pain, infection, hypertension and neoplasm, although infrequent, have been reported. Acute, life-threatening complications resulting from the size of the affected kidney are rare and emergency nephrectomy has been the only reported effective therapy. We present a case of ultrasound-guided percutaneous cyst decompression used as definitive treatment of respiratory failure associated with multicystic dysplastic kidney.

Emphysematous Pyelonephritis

Six patients (all women, mean age 59.8 years) with emphysematous pyelonephritis, a rare, severe inflammation causing renal parenchymal destruction and affecting diabetics more commonly than non-diabetics, are described. Four of the patients were diabetics. All underwent ultrasound examination (US), and five computed tomography (CT) of the kidneys. CT was the most reliable diagnostic method. Differentiation between gas and calcification was difficult at US in three patients. Conventional tomography was performed in two patients and showed intra-renal gas. All six patients recovered; three patients had nephrectomy, one as an emergency procedure and two as an elective procedure after two weeks of antibiotic treatment. Infection was eradicated in the other three patients by percutaneous drainage, electrolyte correction and antibiotics. It was concluded that while conventional abdominal radiography may permit the diagnosis of emphysematous pyelonephritis by demonstrating intra-renal gas, CT is the most reliable diagnostic examination. Emergency nephrectomy may not be necessary in all cases.

Chest Mass in a Paraplegic

A 38-year-old man came to the emergency room with the chief complaint of nonproductive cough, nasal congestion, and bilateral anterior pleuritic chest pain of two days’ duration. He had smoked one pack of cigarettes per day for 20 years and was otherwise healthy and without complaints. The patient was paraplegic as a result of a left flank gunshot wound during the Vietnam War 20 years earlier. At that time, he required emergent left nephrectomy, splenectomy, and repair of the left hemidiaphragm.

Frequency of development of early cortical scarring in acute primary pyelonephritis

Fifty-five cases of primary (that is, without urinary tract abnormalities), acute pyelonephritis (PN) were studied by computed tomodensitometry (CT). There were 48 women and 7 men. All were febrile and 16 had positive blood cultures. In 7 cases, (4 diabetics and 3 malnourished alcoholics) PN was painless, diagnosis was delayed and lesions were severe. Two diabetics underwent emergency nephrectomy for sepsis. Conventional radiological techniques (IVP and ultrasonography) were poorly informative. In contrast, initial CT abnormalities were visible in 44 patients. They consisted of triangular or round hypodense images, diffuse hypodensity in a grossly swollen kidney, and/or abscesses. Hypodense images were presumably due to acute focal ischemia. Renal histology was available in five patients. It showed acute interstitial nephritis with leukocyte infiltrates, edema and hemorrhagic streaks. Pyelonephritis was due to E. coli in 48 cases (87.5%). In 27 cases E. coli isolates were studied by genotypic assays which detect the three most frequent (pap, afa and sfa) of the four operons known to encode adhesin. In all cases, at least one of these genotypic markers of uropathogenicity was found. In 27 cases, repeat CT was done shortly after treatment. It showed healing in only 12. Early cortical scar formation was visible in 2. Final evaluation in 27 cases with adequate follow-up showed that (in addition to the 2 patients who had been nephrectomized), in only 17 of 27 (63%) had the kidneys recovered a normal appearance. In two cases one kidney had undergone atrophy; renal biopsy showed subacute-chronic interstitial nephritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal carbuncle: Comparison between surgical open drainage and closed percutaneous drainage

This article represents a retrospective study of 12 patients with renal carbuncle treated at the combined urological services of The Mason Clinic in Seattle, Washington, and Madigan Army Medical Center in Tacoma, Washington. All patients were initially treated with antibiotics. Two recovered without further treatment. Of the 10 patients who failed to respond, 2 underwent nephrectomy for nonfunctioning kidneys, 4 underwent closed percutaneous drainage, and 4 underwent surgical open drainage. All patients treated with open surgical drainage recovered and retained functioning kidneys. Of the 4 patients who underwent closed percutaneous drainage, 2 failed to respond and required subsequent emergency nephrectomy because of sepsis. The authors believe that renal exploration and open drainage should be the initial definitive mode of surgical treatment of renal carbuncle in those patients who fail antibiotic therapy alone.

Cardiovascular changes after bilateral nephrectomy

Patients with chronic renal failure necessitating long-term hemodialysis and/or consideration for renal transplantation often have significant hypertension. Though most patients can be successfully managed with antihypertensive medications, some patients are either resistant to aggressive management or demonstrate sufficient liability to make medication dosage difficult. Bilateral nephrectomy has been advocated as an adjunctive mode of therapy in such patients. Hypertension might be ameliorated or controlled completely if the chronically diseased kidneys had contributed to hypertension. Further, bilateral nephrectomy may be considered as an adjunctive form of therapy to aid in the management of patients with certain end-stage diseases. Indications include a wide spectrum from life-saving nephrectomy in patients with Goodpasture’s Syndrome [5] to the removal of huge polycystic kidneys to allow room for placement of a renal homograft [I 11. In general however, the largest group of patients in whom this measure is indicated are those with significant hypertension uncontrollable by aggressive dialysis and antihypertension medications [l, 8, 9, lo]. Such patients may even require emergency nephrectomy [8]. The perioperative care of patients with significant hypertension makes understanding of the relationships between the factors controlling stroke volume difficult. Distribution of extracellular volume, the relationship between intravascular volume and ventricular filling pressures, stroke volume and cardiac work, as well as the effects of increased afterload are difficult to predict with any accuracy in patients maintained on hemodialysis and receiving antihypertensive medications. With the advent of practical, precise cardiovascular monitoring, all important variables can be accurately measured and calculated. In addition, the actual effect of bilateral nephrectomy on the interrelationships between cardiac output, blood pressure, and peripheral resistance can be documented. Finally, in the case of hypotension or other cardiovascular abnormalities, appropriate interventions based on the demonstrated abnormalities could be instituted.

Spontaneous intraperitoneal rupture of hydronephrosis.

Intraperitoneal rupture of hydronephrosis is an uncommon condition. Pre-operative diagnosis is difficult, but there is usually a clear indication for emergency laparotomy. Early drainage is essential for survival, and is preferable to emergency nephrectomy, allowing subsequent full investigation of renal function with the possibility of elective conservative surgery in some cases.

Delayed hemorrhage after percutaneous kidney biopsy.

A case of delayed hemorrhage from the kidney after a percutaneous renal biopsy occurred on the ninth day after the diagnostic procedure and required an emergency nephrectomy. Report of a Case A 41-year-old man was admitted to the Metropolitan Hospital because a preemployment chest x-ray showed bilateral pleural effusions. Two weeks earlier the patient had experienced the onset of nocturnal orthopnea. There had been no chills, fever, or night sweats. The patient had been essentially well until nine months prior to admission, when he developed lymphadenopathy, muscular weakness, and a wasting of the muscles of the lower extremities. A diagnosis of Guillain-Barre syndrome was made and the patient treated at another hospital with cortisone and physiotherapy. During this four-month hospitalization and the subsequent four-month follow-up, the patient had no hypertension or abnormal urinary findings. One month prior to his admission to Metropolitan Hospital his blood pressure was normal, but for