ESPN 51th Annual Meeting

ESPN 2018


 
Percutaneous Nephrostomy Experience in Urosepsis Secondary to Pyonephrosis: Case Report
EREN SOYALTIN 1 CANER ALPARSLAN 1 FATMA MUTLUBAŞ 1 DEMET ALAYGUT 1 SEÇIL ARSLANSOYU ÇAMLAR 1 BELDE KASAP DEMIR 2 ÖNDER YAVAŞCAN 1

1- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, IZMIR, TURKEY
2- IZMIR KATIP ÇELEBI UNIVERSITY DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, IZMIR, TURKEY
 
Introduction:

Percutaneous nephrostomy (PN) is a useful therapeutic procedure for pyonephrosis in VUR patients. Herein we reported a case with bilateral grade V VUR, end stage renal disease (ESRD) and urosepsis due to unresolved pyonephrosis improved with treatment of PN drainage. 

Material and methods:

A 9-year-old girl who had been diagnosed with neurogenic bladder and chronic kidney disease for 8 years, admitted to hospital with cloudy urine, abdominal pain, abdominal distension, fatigue and vomiting. She has paleness and tachycardia. Laboratory findings revealed anemia (hb: 5.2 gr/dL), high levels of serum creatinine (11.3 mg/dL), urea (525 mg/dL) and uric acide (10.2 mg/dL). Metabolic acidosis was detected in arterial blood gas analysis (pH: 7.13 HCO3: 10.2, BE: -18.1). Urine dipstick and microscopy showed to UTI. The patient was admitted to hemodialysis program with the diagnosis of ESRD as well as meropenem (40 mg/kg/day) therapy was intravenously started and continued to due to detection of Pseudomonas spp. in urine culture. However, patient has continued to intermittent febrile periods at the first week of hospitalization. She had hypotension, low oxygen saturation, prolonged capillary filling time and blurred consciousness during hemodialysis. Intravenous fluid and inotropic treatments were initiated because of she was evaluated as septic shock. Piperacillin tazobactam was added to the meropenem treatment. Ultrasonography revealed an enlarged left kidney with a dilated pelvis filling with purulent fluid.

Results:

We performed PN in left kidney. It providedthat 600 cc purulent urine drainage of the renal pelvis and calyces within 2 days. After the application of PN, clinical laboratory condition was stabilized. On the 6th day, nephrostomy tube was removed after the urine was sterile.

Conclusions:

 PN should be kept in mind as an effective treatment in pyonephrosis. We believe that pediatric nephrologists should be able to perform PN placement, especially in developing pediatric nephrology centers.