title: Extensive emphysematous pyelonephritis in a renal allograft treated conservatively: case report and review of the literature.
abstract: Emphysematous pyelonephritis (EPN) is a rare occurrence in renal allografts. An aggressive approach resulting in transplant nephrectomy is viewed as the standard of care. Over the recent years, treatment with percutaneous drainage (PCD) of the renal and perinephric collections and appropriate antibiotics has been reported with good success in lesser grades of this infection. Only 4 cases of extensive EPN disease with Escherichia coli, treated with conservative management, are reported in the English-language literature. We present a case of severe EPN caused by Klebsiella pneumoniae, successfully managed with early PCD, and propose a step-up strategy aimed toward graft preservation.
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India. suceena@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.forename: S
authors.initials: S
authors.lastname: Varughese
authors.forename: V G
authors.initials: VG
authors.lastname: David
authors.forename: S V
authors.initials: SV
authors.lastname: Kodgire
authors.forename: R P
authors.initials: RP
authors.lastname: Mukha
authors.forename: N S
authors.initials: NS
authors.lastname: Kekre
authors.forename: V
authors.initials: V
authors.lastname: Tamilarasi
authors.forename: C K
authors.initials: CK
authors.lastname: Jacob
authors.forename: G T
authors.initials: GT
authors.lastname: John
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004322:Drainage; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation / Q000009:adverse effects*; D007710:Klebsiella Infections / Q000188:drug therapy / Q000209:etiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D008875:Middle Aged; D011704:Pyelonephritis / Q000188:drug therapy* / Q000209:etiology* / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents