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Abstract: SA-PO053

Biopsy Proven Bilateral Pyelonephritis Caused AKI Requiring Hemodialysis: Case Report and Review

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Yaseen, Najjar, Albany Medical Center, Albany, New York, United States
  • Hernandez, Laura, Albany Medical Center, Albany, New York, United States
  • Monrroy, Mauricio, Albany Medical Center, Albany, New York, United States
Introduction

Severe acute kidney injury requiring dialysis caused by only acute pyelonephritis (APN) is rare. A study showed that APN caused AKI in 26.5% and kidney failure in 11.5%. Risk factors were chronic kidney disease, older age, bilateral renal involvement, and hemodynamic shock [1]. Here, we present a case of pyelonephritis leading to acute renal failure requiring hemodialysis with subsequent recovery of kidney function in a patient without prior kidney disease.

Case Description

66-year-old woman presented with fever for 4 days and abdominal pain, no use of nephrotoxics. On exam, she was febrile (102.6F), tachycardic, normotensive, and fluid overload. Labs showed WBC 19.6x103/uL, Na 126mEq/L, creatinine 3.69mg/L, (baseline 0.75 mg/l). CT showed normal kidneys. Blood and urine culture grew E. Coli. Dialysis was started for anuria and hypervolemia. To explain AKI, biopsy was done showing ATN and acute and chronic pyelonephritis with 80% parenchyma destruction with minimum scaring. Day 18, CT showed no renal abscess but new finding of multiple bilateral wedge-shaped hypodensities. Kidney function recovered completely. Dialysis was completely weaned off. Repeated CT showed resolution of kidney hypodense wedges. After 7 weeks of hospitalization, patient was discharge to physical rehabilitation with creatinine and urine output of 2.5mg/L and 1700ml/24hr.

Discussion

Only 16 cases were reported of biopsy proven renal failure secondary to APN with normal kidneys [2]. In absence of hemodynamic instability and nephrotoxicity, (APN) was sole cause for AKI-requiring dialysis. Rarity of pyelonephritis to cause AKI to this extend of severity along with complete recovery make this case novel to literature.

1. Jeon, D.H., et al., Incidence, risk factors, and clinical outcomes of acute kidney injury associated with acute pyelonephritis in patients attending a tertiary care referral center. Ren Fail, 2019. 41(1): p. 204-210.
2. Jones, S.R., Acute renal failure in adults with uncomplicated acute pyelonephritis: case reports and review. Clin Infect Dis, 1992. 14(1): p. 243-6.