Pol. Merkur. Lek (Pol. Med. J.), 2018, XLIV/262: 196-200 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2018, XLIV/262: 196-200

Title: Pyonephrosis as the first symptom of congenital hydronephrosis in a 6-year old girl 

Authors: Dudek-Warchoł T, Warchoł S, Bombiński P, Toth K, Szmigielska A, Krzemień G. 

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Pyonephrosis as the first symptom of congenital hydronephrosis in a 6-year old girl

Dudek-Warchoł T1, Warchoł S1, Bombiński P2, Toth K3, Szmigielska A4, Krzemień G4.

1Department of Pediatric Surgery and Urology, Medical University of Warsaw; 2Department of Pediatric Radiology, Medical University of Warsaw; 3Nuclear Medicine Laboratory Nukleomed, Warsaw; 4Department of Pediatrics and Nephrology, Medical University of Warsaw

Pyonephrosis in the course of hydronephrosis usually provides to total or near-total loss of renal function. In adults pyonephrosis usually results from urolithiasis. In children usually congenital urinary tract anomalies are present as contributing factors.
Case report
. 6-year old girl was admitted to the hospital because of 2-day history of high fever, abdominal pain, progressive deterioration of general condition and ultrasonographically (US) detected left hydronephrosis. US on admission showed grossly dilated left renal collecting system together with extensive echogenic debris and laboratory tests highly elevated inflammatory markers. Once diagnosis of pyonephrosis was established on the basis of clinical picture and US as well as laboratory tests results, nephrostomy tube was placed percutaneously. Pus culture obtained during placement of nephrostomy showed E.Coli ESBL (-) growth. Intensive antibiotic treatment (Meropenem) was continued for 3 weeks, nephrostomy was removed after 12 days after receiving normal urine. Further evaluation of urinary tract (US and computed tomography urography) showed large hydronephrosis due to ureteropelvic junction obstruction, while dynamic scintigraphy obstructive renogram with grossly diminished left kidney function to 20% of differential renal function. The girl was referred for operative treatment on urgent basis. Intraoperatively long distance utreteropelvic junction stenosis was found and dismembered Anderson- Hynes pyeloplasty was performed. During 2-years follow-up postoperatively US showed gradually decrease of dilatation of left renal collecting system, while dynamic scintigraphy revealed permanent improvement of drainage together with almost normal renal function (up to 45%). No urinary tract infections were noted. Conclusions. Proper management of pyonephrosis in hydronephrotic kidney due to congenital ureteropelvic junction obstruction enables good final result of treatment.

Key words: pyonephrosis, congenital hydronephrosis, nephrostomy, dismembered Anderson-Hynes pyeloplasty

Pol Med J, 2018; XLIV (262); 196–200