[Severe chronic renal failure subsequent to acute pyelonephritis in alcoholic patients].
BACKGROUND
Chronic alcoholism and malnutrition are uncommon causes of complicated acute pyelonephritis (APN).


METHODS
Since 1997, we have seen 5 patients with chronic alcoholism (3 women and 2 men, mean age 53.4 +/- 13 years) without cirrhosis, diabetes or renal failure who developed severe APN in a state of malnutrition (albumin 22 +/- 3 g/l, total cholesterol 0.86 +/- 0.2 g/l). Diagnosis was made 14.6 +/- 9 days after onset of atypical symptoms which the patients neglected. There was a major bacterial inoculum: Escherichia coli 10(6.2 +/- 2) (3 multisusceptible and 2 amoxicillin-resistant strains); positive blood cultures in 3 cases. The imaging study showed bilateral diffuse lesions with focal swelling and kidney enlargement, without obstacle, abscess, or papillary necrosis. All patients had severe acute renal failure (maximum serum creatinine: 582 +/- 210 mumol/l; 3 patients underwent dialysis). Mean duration of antibiotic therapy was 40 +/- 7 days (i.v.: 22 +/- 3 d). Renal scarring occurred since creatinine clearance was 33 +/- 22 ml/min 2 months after the initial episode. One patient progressed to end-stage renal failure.


CONCLUSIONS
In malnourished alcoholic patients, APN may be unusually severe due to late diagnosis leading to the risk of irreversible renal damage and severe chronic renal failure.
Ladrière
M
M
Service de Néphrologie, Centre Hospitalier Universitaire de Nancy.
Cormier
L
L
Claudon
M
M
Renoult
E
E
Clavel
P
P
Kessler
M
M
Frimat
L
L
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology*; D007677:Kidney Function Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000150:complications; D011704:Pyelonephritis / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed
D003404:Creatinine