Abstract: FR-PO063
Unresolving Renal Failure After Treatment of UTI
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Raksasuk, Sukit, Siriraj Hospital, Bangkok, Thailand
- Chawanasuntorapoj, Ratana, Siriraj Hospital, Bangkok, Thailand
- Cheunsuchon, Boonyarit, Siriraj Hospital, Bangkok, Thailand
Introduction
Malakoplakia is a rare granulomatous inflammation. Most of the patients had the history of previous urinary tract infection and around one-third were immunocompromised hosts. The most common pathogen is Escherichia Coli. Pathogenesis postulated by inadequate lysosomal enzyme in the bactericidal process of macrophages resulting in the specific histological finding of Michaelis-Gutmann bodies. Due to lack of specific radiological morphology, histological diagnosis is mandatory.
Case Description
A 46-year-old alcoholic woman has presented with prolonged fever without any specific organ symptoms after UTI treatment. Laboratory showed Hb 9.6 g% WBC 11990 cell/uL N 92% Platelet 21,000 cell/uL, Cr 6.44 mg/dL, UA: RBC 100-200/HP, WBC 30-50/HP, few bacteria. Hemoculture was E.Coli. After 2 weeks of ATB, she still had septic shock and high creatinine with persistent pyuria. CT scan showed rt.kidney 11x7 cm. and lt.kidney 14x10.6 cm. with heterogeneous density without demarcation of cortex and medulla. Kidney pathology showed 2/3 glomeruli infiltrated with cells described in tubulointerstitial area into Bowman space. The interstitium showed massive infiltration of cells with granular eosinophilic cytoplasm (PAS+, PASD resistant). These cells were marked with CD68, a histiocytic marker. There were a few round basophilic lamellated bodies identified as Michaelis-Gutman bodies. AFB and GMS stains were negative. She was continuing antibiotic and surgical drainage of pus. Due to oliguric AKI with pulmonary edema, she was transiently done hemodialysis. Her clinical was improved and kidney function was recovery with 6 weeks of ATB.
Discussion
Un-resolving renal failure and persistent pyuria after proper antibiotic treatment of UTI in immunocompromised host (alcoholism) with E.Coli sepsis and enlarged heterogeneity kidney introduced the differential diagnosis of complication of UTI such as abscess, malakoplakia, and xanthogranulomatous pyelonephritis or otherwise kidney mass. Due to unexplained cause of kidney injury in our patient, kidney biopsy should be considered. Typical Michaelis-Gutmann bodies in cytoplasm of histiocyte were found. Treatment of renal malakoplakia is prolonged ATB and surgical drainage or resection depend on the severity of kidney damage. Therefore, promptly diagnosis and proper treatment are essential to keep the kidney tissues and function in renal malakoplakia.