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[Dos casos de pielonefritis obstructiva con hiperammonemia que causó un deterioro de la conciencia]
Takao Haitani1, Daisuke Takahashi1, Shigeki Koterazawa1
1The Department of Urology, Ijinkai Takeda General Hospital.
Hinyokika kiyo. Acta urologica Japonica
|September 1, 2025
Resumen
La pielonefritis obstructiva puede causar hiperamonemia, lo que lleva a un deterioro de la conciencia. El tratamiento inmediato, como el cateterismo ureteral, puede mejorar los síntomas neurológicos en estos casos raros.
Área de la Ciencia:
- Nefrología
- Neurología
- Urología
Sus antecedentes:
- La pielonefritis obstructiva es una infección renal grave.
- La hiperammonemia, niveles elevados de amoníaco en la sangre, puede causar disfunción neurológica.
- La asociación entre la pielonefritis obstructiva y la hiperamonemia es rara pero clínicamente significativa.
Objetivo del estudio:
- Informar de dos casos de pielonefritis obstructiva que se presentan con hiperamonemia y deterioro de la conciencia.
- Para resaltar la importancia de considerar la hiperamonemia en pacientes con infecciones del tracto urinario y estado mental alterado.
Principales métodos:
- Informe de caso de dos pacientes ancianas.
- La evaluación diagnóstica incluyó tomografía computarizada (TC) para la hidronefrosis y el hidrouretero.
- Se midieron los niveles de amoníaco en la sangre.
Principales resultados:
- Ambos pacientes presentaron un deterioro de la conciencia y hematuria.
- La TC reveló pielonefritis obstructiva en ambos casos.
- Se observaron niveles elevados de amoníaco en sangre (208 μg/ dl y 133 μg/ dl).
- Los síntomas neurológicos mejoraron después del cateterismo ureteral (10 días y 7 días, respectivamente).
Conclusiones:
- La hiperammonemia es una complicación rara pero potencial de la pielonefritis obstructiva.
- Los médicos deben sospechar hiperammonemia en pacientes con infecciones del tracto urinario y deterioro prolongado de la conciencia.
- El cateterismo ureteral puede ser un tratamiento eficaz para resolver la hiperammonemia y mejorar la conciencia en estos pacientes.
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