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Pyonephrosis

Archie R McGowan, MD
Stuart G Silverman, MD

February 9, 1995

Presentation

An 18-year-old, previously healthy woman presented to emergency services with urinary sepsis and no prior urinary infections.

Imaging Findings

Renal Ultrasound
Nephrotomogram
Retrograde Pyelography

Renal ultrasound demonstrates hydronephrosis of the lower pole of the left kidney with thinning of the renal parenchyma and debris suspicious of blood or pus (arrow).

Nephrotomogram demonstrates a normal right urinary system and confirms the suspicion of a partially duplicated collecting system. There is delayed excretion of contrast media from the lower pole of the kidney, confirming obstruction (arrow).

Retrograde pyelography demonstrates a narrowed ureteropelvic junction without an intrinsic mass or stone. There is debris in the lower pole due to pyonephrosis.

Diagnosis

Pyonephrosis of an obstructed lower pole moiety of a partially duplicated urinary collecting system.

Discussion

Partially duplicated collecting systems are relatively common. In duplicated systems upper pole moiety obstruction is more common than lower pole moiety obstruction. However, obstruction of the lower pole segment can occur. Lower pole moiety hydronephrosis is most often attributed to vesicoureteral reflux. Other causes include congenital ureteral stricture, ureteropelvic junction obstruction, calculi ausing obstruction, epithelial tumors and compression by a upper pole moiety ureter [1].

The likely etiology of the narrowed ureteropelvic junction in this patient is a congenital cause, perhaps secondary to prior reflux.

References

1. Amis ES, et al. Lower moiety hydronephrosis in duplicated kidneys. Urology, July 1985;26(1):82-88.

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