[A rare case of birenal malacoplakia with renal failure].
METHODS
A 45 year old man was admitted to our hospital because of fever, loss of appetite, and deterioration of general health. For two weeks the patient suffered from diarrhea which had resulted in moderate volume depletion. In addition, he complained of bilateral flank pain at the time of admission. Furthermore, the patient had a history of heavily drinking alcohol as well as cigarette smoking for many years. He had never attended a medical doctor before.


METHODS
The patient presented with the clinical picture of acute renal failure and urosepticaemia which was caused by Escherichia coli. The kidneys were found to be at the upper limit of normal by sonography. Magnetic resonance imaging revealed signal-alterations in both kidneys with hyper- and hypointense zones in the renal parenchyma.


METHODS
To clarify the cause of rapid deterioration of renal function, we performed a renal biopsy. The histology of the renal specimen revealed an unusual type acute bacterial interstitial nephritis most likely due to an infection with E. coli. The clinical picture, the laboratory findings and renal histology, lead to the diagnosis of birenal malakoplakia.


METHODS
After intravenous and subsequent oral antibiotic therapy the fever and the clinical signs of urosepticaemia subsided and renal function gradually improved. Antibiotic therapy and supplementation with vitamins were continued for 20 weeks. Five years after initial diagnosis, renal function was stable at a glomerular filtration rate of approximately 45 ml/min.


CONCLUSIONS
Malakoplakia of the kidney is a rare form of bacterial interstitial nephritis and requires long-term antibiotic therapy.
Lehmann
E
E
Medizinische Klinik I, Kliniken der Stadt Köln, Medizinische Fakultät der Universität zu Köln. Lehmanne@Kliniken-Koeln.de
Fries
J
J
Schulze-Lohoff
E
E
Weber
M
M
D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000382:microbiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008287:Malacoplakia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000150:complications / Q000382:microbiology* / Q000473:pathology; D014815:Vitamins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014815:Vitamins