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Emphysematous pyelonephritis with gas in inferior vena cava.

ABSTRACT: Emphysematous pyelonephritis (EPN) is a progressive necrotizing infection of the renal parenchyma, collecting system and perinephric tissue. A 36-year female with uncontrolled diabetes, presented with left emphysematous pyelonephritis, with air in the infra-hepatic inferior vena cava (IVC). She was hydrated, treated with intravenous antibiotics, insulin. Percutaneous nephrostomy with Double J stenting was done in modified supine position. Patient was discharged with nephrostomy. Two weeks later, flexible ureterorenoscopy was done and obstructing papillary necrosis removed. Pneumo-vena cava due to emphysematous pyelonephritis is quite rare and careful evaluation is required. Prompt intervention is life saving and obviates the need for nephrectomy.

SUBMITTER: Vaddi CM

PROVIDER: S-EPMC7574042 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Introduction Kidney and liver cysts in autosomal dominant polycystic kidney disease (ADPKD) can compress the inferior vena cava (IVC), but IVC compression prevalence and its risk factors are unknown. Methods Patients who have ADPKD (n = 216) with abdominal magnetic resonance imaging (MRI) studies and age-/sex-matched controls (n = 216) were evaluated for IVC compression as well as azygous vein diameter (a marker of collateral blood flow) and IVC aspect ratio (left-to-right dimension divided by anterior-to-posterior dimension with a value of 1 corresponding to a circular (high pressure) IVC caudal to compression. Results Severe IVC compression (?70%) was observed in 33 (15%) ADPKD subjects and mild compression (?50% to <70%) was observed in 33 (15%) subjects; whereas controls had no IVC compression (P < 0.001). Severe IVC compression was associated with larger azygous vein (4.0 ± 1.3 mm versus 2.3 ± 0.8 mm without IVC compression; P < 0.001) and a more circular IVC cross-section upstream (mean IVC aspect ratio: 1.16 ± 0.27 vs. 1.69 ± 0.67, P < 0.001), suggesting higher pressure upstream from the compression. IVC compression was associated with older age, lower estimated glomerular filtration rate (eGFR), greater height-adjusted total kidney volumes, greater height-adjusted liver volume (ht-LV), and greater liver and renal cyst fractions (P < 0.001). No subject younger than 30 years had IVC compression, but ADPKD subjects ?40 years old had 12-fold higher risk of IVC compression (95% confidence interval [CI]: 4.2–42.4), with highest predicted probability for Mayo Clinic classes 1D (59%; 95% CI: 39%–76%) and 1E (74%; 95% CI: 49%–90%) after adjustment (P < 0.001). Women with ht-LV ? 2000 ml/m had 83% (95% CI: 59%–95%) prevalence of IVC compression. Complications of IVC compression included deep vein thrombosis (DVT) and symptomatic hypotension. Conclusions IVC compression is common in ADPKD patients >40 years old, with Mayo Clinic class 1D/E, and in females with ht-LV > 2000 ml/m. Graphical abstract

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Emphysematous pyelonephritis with gas in inferior vena cava.

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