Absceso Renal, Pielonefritis Enfisematosa y Xantogranulomatosa Expo Coutiño Ok Ok

Renal Abscess,
Xanthogranulomatous
Pyelonephritis and
Emphysematous Pyelonephritis
Dr. Iber Arroyo Coutiño R3U
SERVICIO DE UROLOGIA CMN SXXI
Renal Abscess
• Is a collection of purulent material confined to the renal

parenchyma.
• Before the antimicrobial era, 80% of renal abscesses were

attributed to hematogenous seeding by staphylococci.
Capmbell Walls Urology 10th Edition, Chapter 10, infections of the Urinary
Tract. Pag. 301.
Renal Abscess
• The partially obstructed kidney rejects blood borne
gramnegative inocula as well as a normal kidney.
• Although the association of pyelonephritis with

vesicoureteral reflux is well established.
• The association of renal abscess with vesicoureteral reflux

has been infrequently.
Tract. Pag. 301.
Renal Abscess
• Recent observations, indicate that reflux is frequently

associated with renal abscesses and persists long after
sterilization of the urinary tract.
Tract. Pag. 301.
Emphysematous
Pyelonephritis
• Is a urologic emergency.
• Characterized by an acute necrotizing parenchymal.
• Perirenal infection caused by gas-forming uropathogens.
Tract. Pag. 299.
Emphysematous
Pyelonephritis
• Usually occurs in diabetic patients.
• It has been postulated that the high tissue glucose levels

provide the substrate for microorganisms such as E. coli.
• For produce carbon dioxide by the fermentation of sugar.
Tract. Pag. 299.
Emphysematous
Pyelonephritis
• In addition to diabetes, many patients have urinary tract
obstruction.
• Associated with urinary calculi.
• Papillary necrosis and significant renal functional.
• The overall mortality rate has been reported to be between

43% and 19%.
Tract. Pag. 299-300.
Xanthogranulomatous
Pyelonephritis
• Is a rare, severe, chronic renal infection typically resulting in

diffuse renal destruction.
• Most cases are unilateral and result in a nonfunctioning,

enlarged kidney associated with obstructive uropathy
secondary to nephrolithiasis.
Tract. Pag. 307.
Xanthogranulomatous
Pyelonephritis
• Is characterized by accumulation of lipid laden foamy

macrophages.
• Begins within the pelvis and calyces and subsequently

extends into and destroys renal parenchymal and adjacent
tissues.
Tract. Pag. 308.
ABSCESO RENAL
• Material purulento.
• Limitado al parénquima renal.
Tract. Pag. 301.
ABSCESO RENAL
1950-1970
ANTIBIOTICOS
GRAM + GRAM -
Tract. Pag. 301.
BACTERIOLOGIA
• E. coli (51.4%)
• S. aureus (10%)
• K. pneumoniae (8.6%)
Renal and perinephric abscess. Up to date. Jun 2017.

ABSCESO RENAL
VIAS DE INFECCION
Tract. Pag. 301.
ABSCESO RENAL
FACTORES DE RIESGO
- Diabetes mellitus.
- Embarazo.
- Anomalías del tracto urinario.

ABSCESO RENAL
ETIOLOGIA
Tract. Pag. 301.
ABSCESO RENAL
CUADRO CLINICO
Tract. Pag. 302.
ABSCESO RENAL
PRUEBAS DE LABORATORIO
• Bh
• Qs
• Es
• EGO
• CULTIVOS
Tract. Pag. 302.
ABSCESO RENAL
GABINETE
• PSA

ABSCESO RENAL
GABINETE
• USG

ABSCESO RENAL
GABINETE
• TAC

ABSCESO RENAL
TRATAMIENTO
Regimens for empiric therapy
Piperacillin-tazobactam 3.375 g every 4 hours or 4.5 g every 6 hours
Ticarcillin-clavulanate* 3.1 g every 4 hours

Cefepime 1 g every 8 hours or 2 g every 12 hours
Meropenem 1 g every 8 hours
Imipenem 500 mg every 6 hours
Regimens for therapy when susceptibility data are available
Ceftriaxone 1 g every 24 hours
Ciprofloxacin 400 mg every 12 hours
Levofloxacin 500 to 750 mg every 24 hours

Aztreonam 1 g every 8 hours
Regimens for empiric therapy in the setting of S. aureus bacteremia
Nafcillin 2 g every 4 hours
MSSA Oxacillin 2 g every 4 hours
Cefazolin 2 g every 8 hours
¶ 15 to 20 mg/kg every 12 hours (maximum 2 g

MRSA Vancomycin Δ
per dose)

ABSCESO RENAL
TRATAMIENTO
Antibiotic Dose (interval)
500 to 750 mg every 24
Levofloxacin
hours
Ciprofloxacin 500 mg every 12 hours
Ciprofloxacin XR 1000 mg every 24 hours
Trimethoprim- 1 double strength
sulfamethoxazole tablet* every 12 hours
Trimethoprim 100 mg every 12 hours
Cefpodoxime 200 mg every 12 hours
Cefixime 200 mg every 12 hours
¶
Amoxicillin 1000 mg every 8 hours

ABSCESO RENAL
TRATAMIENTO QUIRURGICO
- Tamaño.
- Síntomas clínicos y los hallazgos radiográficos.
- Permanencia del drenaje.
- Percutáneo > abierto

Pielonefritis
xantogranulomatosa
• Enfermedad inflamatoria crónica.
• Con una característica histológica: “ Células espumosas”.
• Con presencia de abscesos y granulomas.
Pielonefritis xantogranulomatosa y malacoplasia renal, Revista de Ciencias

Médicas de la Habana 2014.
Pielonefritis
xantogranulomatosa
• Unilateral.
• Función anulada.
• Infrecuente.
Tract. Pag. 307.
Patogenesis
• Nefrolitiasis.
• Obstrucción.
• Infección.
Tract. Pag. 307.
Pielonefritis
xantogranulomatosa
Patogenesis
• Células xantogranulomatosas se distribuyen alrededor del
absceso.
• Bacterias de baja virulencia.
• Otros posibles factores interrelacionados.
Tract. Pag. 307.
PATOLOGIA
• Aumento masivo renal con contorno normal.
• Dos comportamientos:
Tract. Pag. 307.
Pielonefritis xantogranulomatosa
Presentación clínica
• IVU +
Tract. Pag. 308.
Tract. Pag. 307.
Diagnóstico
BACTERIANO
PROTEUS
E. COLI
Tract. Pag. 308.
Diagnóstico
Tract. Pag. 308.
Diagnóstico diferencial
Tract. Pag. 309.
Tratamiento
VS
Tract. Pag. 309.
Pielonefritis enfisematosa
• Emergencia.
• Infección aguda necrosante.
• Uropatogenos formadores de gas.
Tract. Pag. 299.
Tract. Pag. 299.
• Adultos.
• Sexo femenino.
• Pielonefritis aguda grave.
• Riñon izquierdo > derecho
Tract. Pag. 299.
TRAIADA:
• Fiebre, vomito y dolor lumbar.
Tract. Pag. 300.
E. Coli
Klebsiella
Proteus
Tract. Pag. 300.
Laboratorio
• Leucocitosis.
• Trombocitopenia.
• Agudización de la función renal.
Experencia en el manejo de la pielonefritis enfisematosa.

2012.
Hallazgos radiológicos
Tract. Pag. 301.
• TAC
Pielonefritis enfisematosa. Estudios radiológicos, TC, US, para su diagnóstico y

tratamiento. Pag. 11.
• TAC

Hallazgos radiológicos y tramiento
• TAC

Factores de desenlace adverso
Experencia en el manejo de la pielonefritis enfisematosa.

2012.

Absceso Renal, Pielonefritis Enfisematosa y Xantogranulomatosa Expo Coutiño Ok Ok

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Renal Abscess,

• Is a collection of purulent material confined to the renal

• Before the antimicrobial era, 80% of renal abscesses were

• Although the association of pyelonephritis with

• The association of renal abscess with vesicoureteral reflux

• Recent observations, indicate that reflux is frequently

• Characterized by an acute necrotizing parenchymal.

• Perirenal infection caused by gas-forming uropathogens.

• It has been postulated that the high tissue glucose levels

• For produce carbon dioxide by the fermentation of sugar.

• Associated with urinary calculi.

• Papillary necrosis and significant renal functional.

• The overall mortality rate has been reported to be between

• Is a rare, severe, chronic renal infection typically resulting in

• Most cases are unilateral and result in a nonfunctioning,

• Is characterized by accumulation of lipid laden foamy

• Begins within the pelvis and calyces and subsequently

• Limitado al parénquima renal.

Renal and perinephric abscess. Up to date. Jun 2017.

- Anomalías del tracto urinario.

Renal and perinephric abscess. Up to date. Jun 2017.

Renal and perinephric abscess. Up to date. Jun 2017.

Renal and perinephric abscess. Up to date. Jun 2017.

Renal and perinephric abscess. Up to date. Jun 2017.

Piperacillin-tazobactam 3.375 g every 4 hours or 4.5 g every 6 hours

Ticarcillin-clavulanate* 3.1 g every 4 hours

Levofloxacin 500 to 750 mg every 24 hours

¶ 15 to 20 mg/kg every 12 hours (maximum 2 g

Renal and perinephric abscess. Up to date. Jun 2017.

Renal and perinephric abscess. Up to date. Jun 2017.

- Síntomas clínicos y los hallazgos radiográficos.

- Permanencia del drenaje.

- Percutáneo > abierto

Renal and perinephric abscess. Up to date. Jun 2017.

• Con una característica histológica: “ Células espumosas”.

• Con presencia de abscesos y granulomas.

Pielonefritis xantogranulomatosa y malacoplasia renal, Revista de Ciencias

• Bacterias de baja virulencia.

• Otros posibles factores interrelacionados.

• Infección aguda necrosante.

• Uropatogenos formadores de gas.

• Pielonefritis aguda grave.

• Riñon izquierdo > derecho

• Fiebre, vomito y dolor lumbar.

• Agudización de la función renal.

Experencia en el manejo de la pielonefritis enfisematosa.

Pielonefritis enfisematosa. Estudios radiológicos, TC, US, para su diagnóstico y

Pielonefritis enfisematosa. Estudios radiológicos, TC, US, para su diagnóstico y

Pielonefritis enfisematosa. Estudios radiológicos, TC, US, para su diagnóstico y

Experencia en el manejo de la pielonefritis enfisematosa.

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