대한신장학회

논문분류	춘계학술대회 초록집
제목	A Case of Successfully Treated Acute Pyelonephritis with Ureteral Stricture in a Patient with Chronic Kidney Disease
저자	Hye Mi Choi, Byung Sun Kim, Woong Ki Lee, Choong Sil Seong, Hyeuk Soo Lee,Jeong Gwan Kim, Kwang Young Lee, In O Sun
출판정보	2013; 2013(1):
키워드	요관 협착, 급성신우신염/Ureteral stricture, Acute pyelonephritis
초록	Introduction: Acute kidney injury associated with acute pyelonephritis caused by segmental ureteritis is not common. We report a case of acute kidney injury caused by segmental ureteritis successfully treated by percutaneous nephrostomy and antibiotics therapy. Case: A 65-year-old Korean woman with a history of diabetes visited our emergency department complaining of lower abdominal pain for 3 days with fever of 38.5℃. Her blood pressure was 100/50 mmHg and heart rate 120 beats/min. Urine analysis showed turbid appearance with obvious pyuria and hematuria. Initial laboratory findings revealed an elevated white blood cell count (14.6×103/mL) and CRP (14 mg/ dL). Blood urea nitrogen and serum creatinine concentrations were 114 mg/dL (normal: 8-20 mg/dL) and 5.8 mg/dL (normal: 0.6-1.2 mg/dL), respectively. Computed tomography and sonography showed left pyelonephritis with hydronephrosis. The ultrasonogram of the right kidney showed increased renal parenchymal echogenicity with subtle obliteration of the corticomedullary differentiation, which suggested of chronic kidney disease. The urine culture revealed Enterococcus faecium. After percutaneous nephrostomy and appropriate antibiotic therapy, the creatinine level decreased from 5.8 mg/dL to 1.6 mg/dL on the 30th day of admission. During the evaluation of the cause of hydronephrosis in left kidney, ureteral stricture was detected by pelvic magnetic resonance imaging (MRI) and intravenous pyelography. At the 30th day of admission, ureteral stricture was relieved partially. But we could not remove percutaneous nephrostomy because of recurrent pyelonephritis while clamping the drainage of PCN. At the 50th day of admission, we performed antegrade pyelography and confirmed full recovery of ureteral stricture, and then removed PCN. Conclusion: Percutaneous nephrostomy and appropriate antibiotic therapy could be a good treatment options, in case of acute kidney injury associated acute pyleonephritis caused by segmental ureteritis.
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