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Acute Kidney Injury and Hepatic Dysfunction

DOI: 10.4236/oalib.1103581, PP. 1-5

Subject Areas: Nephrology

Keywords: Acute Renal Failure, Hematuria, Proteinuria, Hydronephrosis, Pyelonephritis, Xanthorgranulomatous, Nephrectomy

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Abstract

This clinical report presents a 45-year-old female patient with acute kidney injury, hepatic dysfunction and urosepsis without past history of any illness related to urinary system. Laboratory investigations showed Hb 15.6 gm/dl, neutrophilic leukocytosis, thrombocytes 9000/mm3, ESR 90 mm/h, plasma thromboplastin time (PTT) 48 seconds (control 32 seconds), INR 2, and fibrinogen degradation product 7500 ng/ml (normal <250 ng/ml). Serum creatinine was 450 μmol/L (5.1 mg/dl), direct bilirubin 68.40 μmol/L, alanine aminotransferase 1.6 mmol/L and albumin 25 gm/L. Urinalysis revealed leucocyturia, hematuria without casts and proteinuria. Abdominal plain x-ray revealed left-sided radio-opaque shadow at the ureteric line, left uretero-hydronephrosis with thickened cortex and left ureteric stone, but normal right kidney. Computerized tomography of abdomen showed a large left kidney (13.5 cm) with totally distorted architecture, multiple enhancing and non-enhancing sectors, thickening of renal capsule, moderate dilatation of renal pelvis, dilated ureter and no passage of contrast in the ureter. The patient was treated with a 2-week course of Ceftriaxone and Aztreonam and preoperative session of hemodialysis before the performance of a left-sided nephrectomy. Gross examination revealed adherent capsule, granular cortex covered with purulent exudates, no demarcation between cortico-medullary junction, and the cut surface showed minute abscess and necrosis with markedly dilated pelvis. Light microscopic examination showed fibrosis and inflammation of parenchyma with vacuolized histiocytes foam cells surrounding necrotic areas confirming the diagnosis of xanthogranulomatous pyelonephritis. The patient was discharged after 35 days of hospital stay with normal renal and hepatic function.

Cite this paper

Karkar, A. (2017). Acute Kidney Injury and Hepatic Dysfunction. Open Access Library Journal, 4, e3581. doi: http://dx.doi.org/10.4236/oalib.1103581.

References

[1]  Oosterhof, G.O. and Delaere, K.P. (1986) Xanthogranulomatous Pyelonephritis. Urologia Internationalis, 4F, 180.
https://doi.org/10.1159/000281193
[2]  Parsons, M.A., Harris, S.C. and Longstaff, A.J. (1983) Xanthogranulomatous Pyelonephritis: A Pathological Clinical and Etiological Analysis of 87 Cases. Diagnostic Histopathology, 6, 203.
[3]  Stam, F., Tillar, P.L.M., Flaka, H.M., Gans, R.O.B. and Wee, P.M. (1995) Xanthogranulomatous Pyelonephritis. Nephrology Dialysis Transplantation, 10, 2365- 2367.
https://doi.org/10.1093/ndt/10.12.2365
[4]  Schlagenhaufer, F. (1916) Uber eigentumliche staphylomycosen der nieren und des pararenalen bindegewebes. Frankf Z Pathol, 19, 139-148.
[5]  Cuang, C.K., Lai, M.K., Chang, P.L., et al. (1992) Xanthogranulomatous Pyelonephritis; Experience in 36 Cases. Journal of Urology, 147, 337.
[6]  Malek, R.S. and Elder, J.S. (1978) Xanthogranulomatous Pyelonephritis—A Critical Analysis of 26 Cases and of the Literature. Journal of Urology, 119, 589.
[7]  Goldman, S.M., Hartman, D.S., Fishman, E.K., et al. (1984) CT of Xanthogranulomatous Pyelonephritis: Radiologic-Pathologic Correlation. American Journal of Roentgenology, 141, 963.
https://doi.org/10.2214/ajr.142.5.963
[8]  Huisman, T.K. and Sands, J.P. (1992) Focal Xanthogranulomatous Pyelonephritis Associated with Renal Cell Carcinoma. Urology, 39, 281-284.
https://doi.org/10.1016/0090-4295(92)90307-I
[9]  Chlif, M., Chakroun, M., Rhouma, S., Chehida, M.A., Sellami, A., et al. (2016) Xanthogranulomatous Pyelonephritis Presenting as a Pseudotumour. Canadian Urological Association Journal, 10, E36-E40.
https://doi.org/10.5489/cuaj.3225
[10]  Rajesh, A., Jakanani, G., Mayer, N. and Mulcahy, K. (2011) Computed Tomography Findings in Xanthogranulomatous Pyelonephritis. Journal of Clinical Imaging Science, 1, 45.
https://doi.org/10.4103/2156-7514.84323

[11]  Pattersonnn, J. and Andriole, V. (1987) Renal and Perineal Abscesses. Infectious Disease Clinics of North America, 1, 907-926.
[12]  Elkhammas, E.A., Mutabagani, K.H., Sedmak, D.D., et al. (1994) Xanthogranulomatous Pyelonephritis in Renal Allografts. Report of 2 Cases. Journal of Urology, 151, 127-128.
[13]  Shah, K.J., Ganpule, A.P., Kurien, A., Muthu, V., Sabnis, R.B. and Desai, M.R. (2011) Laparoscopic versus Open Nephrectomy for Xanthogranulomatous Pyelonephritis: An Outcome Analysis. Indian Journal of Urology, 27, 470-474.
https://doi.org/10.4103/0970-1591.91434
[14]  Perez, L.M., Thraster, J.B. and Anderson, E.E.L. (1993) Successful Management of Bilateral Xanthogranulomatous Pyelonephritis by Bilateral Partial Nephrectomy. Journal of Urology, 149, 100.

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