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Encrusted Pyelitis of Native Kidneys

ALEXANDRE HERTIG^*, CHRISTIAN DUVIC, YVES CHRETIEN, PAUL JUNGERS^*, JEAN-PIERRE GRÜNFELD^* and PHILIPPE RIEU^*

^* Department of Nephrology, Necker Hospital, Paris, France.
Department of Urology, Necker Hospital, Paris, France.
Department of Nephrology, Val de Grace Hospital, Paris, France.

Correspondence to Dr. Philippe Rieu, Department of Nephrology and Institut National de la Santé et de la Recherche Médicale U507, Hôpital Necker, 161 rue de Sevres, 75015 Paris, France. Phone: +33 1 44 49 52 47; Fax: +33 1 45 66 51 33; E-mail: rieu{at}necker.fr

Abstract

Abstract. This study reports the first four cases of encrusted pyelitis involving native kidneys. The clinical features, management, and outcome of these patients were analyzed. Predisposing factors were underlying urologic disease and/or urologic manipulations, debilitating diseases, hospitalization, and prolonged antibiotic therapies. Presenting symptoms were renal failure in three patients with ureteroileal urinary diversion and manifestations of cystitis in one patient. Computed tomography scan of the urinary tract was critical for diagnosis. Presence of struvite was demonstrated by crystalluria and infrared spectrophotometry analysis of the encrusted material. Corynebacterium urealyticum urinary infection was identified in one case. Surgery (one patient) and palliative ureteral diversion (one patient), respectively, led to death and end-stage renal failure. Successful dissolution of encrusted pyelitis was obtained in two patients treated with intravenous vancomycin and local acidification of the renal collecting system. Clinical observation shows that encrusted pyelitis is a threatening disorder that destroys the native kidneys and may lead to end-stage renal failure. Successful treatment of the disease by chemolysis and antibiotics depends on correct and early diagnosis. Diagnosis required recognition of the predisposing factors, computed tomography imaging of the urinary tract, crystalluria, and identification of urea-splitting bacteria with prolonged culture on selective medium.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673