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A 42 year old female with pyonephrosis and multiple subcapsular abscesses: saving a threatened kidney

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Author(s): T. Al-Qaoud | A. Al-Terki

Journal: Clinical and Experimental Medical Sciences
ISSN 1314-7528

Volume: 1;
Issue: 2;
Start page: 83;
Date: 2013;
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Keywords: pyonephrosis | subcapsular abscesses | ureteral catheterization

ABSTRACT
Objective: The following report entails how the use of appropriate treatment andimaging leads to an excellent outcome. This description of dealing with a threatenedkidney delineates the importance of critical thinking and application of least invasivetechniques to provide optimum treatment and satisfaction to the patient, avoidingunnecessary loss of a viable kidney.Clinical Presentation: The following case is of a 42 year old woman, presenting withleft loin pain and fever, eventually diagnosed to have a left obstructed kidney due to a stone with pyelonephritis complicated by pyonephrosis and multiple subcapsularabscesses.Intervention: While in hospital, the patient received appropriate antibiotics, had aureteric stent placed initially while the stone was manipulated into the left kidney,followed by drainage of two large subcapsular abscesses. Following discharge, duringfollow up she had the stent and stone removed rendering her symptom and stone free.CT was the imaging modality used in hospital and for follow up.Conclusion: When faced with multiple pathologies, such as our case, using goldstandard imaging and tapering treatment to patient characteristics and needs, helped ustackle different pathologies in a step-wise manner with an excellent endpoint. The useof ureteric stenting, combined with percutaneous drainage of the subcaspularabscesses, was an excellent choice, one that saved the patient her left kidney.
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