Abstract: TH-PO604
Encrusted Pyelitis in a Patient with Solitary Functional Kidney
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Chalasani, Meghana, University of Utah, Salt Lake City, Utah, United States
- Horowitz, Bruce, University of Utah, Salt Lake City, Utah, United States
- Abraham, Josephine, University of Utah, Salt Lake City, Utah, United States
Introduction
Encrusted pyelitis is a rare infectious disease affecting the urothelium and is usually caused by Corynebacterium urealyticum, a non-hemolytic gram-positive bacillus.
Case Description
A 79-year old woman with a history of urothelial carcinoma and atrophic left kidney was found on a surveillance abdominal CT scan to have linear calcifications within the collecting system of the right kidney with bilateral urothelial thickening concerning for encrusted pyelitis. Patient was diagnosed with urothelial carcinoma after a CT scan done for evaluation of painless hematuria showed severe left hydronephrosis with a focal enhancing mass at the left uretero-vesicular junction. She did not have evidence of metastases and underwent radical cystectomy with ileal conduit. Scan two months later showed resolution of left hydronephrosis, atrophic left kidney, and normal right kidney. CT scan three months later showed diffuse atrophy of the left kidney with minimal enhancement of the left renal artery, consistent with chronic ischemia and right-sided alkaline encrusted pyelitis. Patient reported urinary discoloration but no fever or dysuria. Serum creatinine remained unchanged. Urine culture was obtained and patient was started on ciprofloxacin. Urine culture was negative. Patient stopped taking the antibiotic due to shoulder pain. Urinalysis one month later showed a pH of 7.5, 5-10 red blood cells and 5-10 white blood cells per high power field, and a large leukocyte esterase. Culture was again negative. CT scan 2 months later showed progression of calcifications. A 24-hour urine stone risk profile is being considered.
Discussion
Encrusted pyelitis is a consequence of lithiasis due to urea-splitting organisms, particularly Corynebacterium urealyticum. Urea is hydrolyzed via urease to ammonium thereby alkalinizing the urine and promoting the formation of magnesium ammonium phosphate stones. Risk factors include endourological procedures, renal transplant, immunosuppression, and prolonged broad-spectrum antibiotics. Complications are ureteral stenosis, renal abscesses, and obstructive uropathy with resultant end-stage renal disease. Diagnosis is suggested by urine culture isolation of a culprit organism and unenhanced imaging which classically shows calcified encrustations in the wall of the urinary tract. Treatment involves antibiotic therapy for at least fourteen days and acidification of the urine.