Emergency percutaneous nephrostomy in the septic kidney

Area of Science:

• Urology
• Nephrology
• Critical Care Medicine

Background:

• Obstructive uropathy can lead to severe complications, including toxico-septic shock.
• Urinary tract infections, particularly those associated with stones (lithiasis), can precipitate this complication.
• Percutaneous nephrostomy (PN) is a key intervention in managing obstructive uropathy.

Purpose of the Study:

• To analyze the incidence and management of toxico-septic shock in patients with obstructive uropathy.
• To evaluate the efficacy of emergency percutaneous nephrostomy in managing this critical condition.
• To assess outcomes and mortality associated with toxico-septic shock in obstructive uropathy.

Main Methods:

• Retrospective study of 250 upper tract obstructive uropathy cases.
• Focus on 64 hospitalized patients with toxico-septic shock.
• Management included emergency percutaneous nephrostomy under local anesthesia, followed by intensive antibiotherapy and supportive care.

Main Results:

• Arterial hypotension was a constant symptom in patients with toxico-septic shock.
• Three patients developed shock after percutaneous nephrolithotomy (PNL) for staghorn or pyelic stones.
• Eleven deaths occurred among the studied patients.
• Successful management involved rapid urinary diversion via percutaneous nephrostomy, followed by antibiotics and intensive care.

Conclusions:

• Emergency percutaneous nephrostomy is crucial for rapid urinary diversion in obstructive uropathy with toxico-septic shock.
• Aggressive management with antibiotics and intensive care is vital for patient survival.
• Subsequent stone removal should be performed after stabilization of the patient's condition.