Pyuria without Casts and Bilateral Kidney Enlargement Are Probable Hallmarks of Severe Acute Kidney Injury Induced by Acute Pyelonephritis: A Case Report and Literature Review

Kohei Odajima; Ryo Togashi; Yoshikazu Nemoto; Yuto Hayama; Shinichiro Asakawa; Michito Nagura; Shigeyuki Arai; Osamu Yamazaki; Yoshifuru Tamura; Makoto Mochizuki; Ryuji Ohashi; Shigeru Shibata; Yoshihide Fujigaki

doi:10.2169/internalmedicine.5721-20

CASE REPORTS

Pyuria without Casts and Bilateral Kidney Enlargement Are Probable Hallmarks of Severe Acute Kidney Injury Induced by Acute Pyelonephritis: A Case Report and Literature Review

Kohei Odajima, Ryo Togashi, Yoshikazu Nemoto, Yuto Hayama, Shinichiro Asakawa, Michito Nagura, Shigeyuki Arai, Osamu Yamazaki, Yoshifuru Tamura, Makoto Mochizuki, Ryuji Ohashi, Shigeru Shibata, Yoshihide Fujigaki

Author information

Kohei Odajima
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Ryo Togashi
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Yoshikazu Nemoto
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Yuto Hayama
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Shinichiro Asakawa
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Michito Nagura
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Shigeyuki Arai
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Osamu Yamazaki
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Yoshifuru Tamura
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Makoto Mochizuki
Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Japan
Ryuji Ohashi
Department of Integrated Diagnostic Pathology, Nippon Medical School, Japan
Shigeru Shibata
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Yoshihide Fujigaki
Department of Internal Medicine, Teikyo University School of Medicine, Japan

Keywords: acute kidney injury, kidney enlargement, nonsteroidal anti-inflammatory drug, pyelonephritis, pyuria

JOURNAL OPEN ACCESS

2021 Volume 60 Issue 2 Pages 293-298

DOI https://doi.org/10.2169/internalmedicine.5721-20

Browse “Advance online publication” version

Details

Abstract

The patient was a 38-year-old man who had experienced nausea and fever for a few days and presented with back pain, oliguria, and pyuria, suggesting acute pyelonephritis (APN). He showed acute kidney injury (AKI) with bilateral kidney enlargement and was using nonsteroidal anti-inflammatory drugs (NSAIDs). AKI-induced by APN was confirmed by kidney biopsy. The AKI was successfully treated with antibiotic therapy. A search of the relevant literature for reports on histopathologically-proven APN-induced severe AKI revealed that the key characteristics were bilateral kidney enlargement with pyuria without casts. Oligoanuria was frequently associated with APN-induced severe AKI, and NSAID use may be a possible risk factor. Prompt antibiotic treatment based on the clinical characteristics of APN-induced AKI can improve the renal outcome.

Corresponding author

Register with J-STAGE for free!