Renal cell carcinoma complicated by emphysematous pyelonephritis in a non-diabetic patient with renal failure.
A 72-year-old non-diabetic uremic woman underwent right nephrectomy for urolithiasis at the age of 50. Because pyuria, fever, chilliness and left flank pain developed during preparing for arteriovenous fistula, she was admitted to National Cheng Kung University Hospital. Renal cell carcinoma (RCC) complicated with emphysematous pyelonephritis (EPN) was diagnosed and immediately treated with antibiotics and CT-guided percutaneous catheter drainage. Cultures of pus and blood yielded Escherichia coli. She received left radical nephrectomy later for the control of persistent sepsis and removal of left renal tumor. The pathology of the tumor was composed of a glandular arrangement of granular cells with the occasional atypism, and renal parenchyma had been totally replaced by RCC. The non-tumor part of the kidney showed chronic pyelonephritis. Five months later, multiple metastases developed. We reported this first uremic case with EPN and RCC, but without diabetes mellitus and urinary tract obstruction. The gas formation may be due to large RCC, which caused impaired tissue perfusion and E. coli infection.
Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan.
Cheng-Hao
CH
Lin
Jeng-Jong
JJ
Huang
Hsin-Liang
HL
Liu
Szu-Yuan
SY
Lee
Ryh-Yaw
RY
Hsieh
Chin-Chung
CC
Tseng
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005740:Gases; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D011704:Pyelonephritis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D051437:Renal Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed
D005740:Gases