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Pendekatan diagnosis dan imaging pyonefrosis et causa urolithiasis dengan hidronefrosis grade IV

Abstract

Background: Pyonephrosis is a progression of a previous disease and rarely occurs in adults, children, and very rarely in neonates. In a study, it was found that out of 550 patients with pyelonephritis, 10.9% of them experienced pyonephrosis. The primary modality typically used is ultrasound, considering its convenience, low cost, and high accuracy in suspected cases of pyonephrosis. Other modalities may include a CT scan, which can provide information on the components of hydronephrotic, the causes, severity, extrarenal extension, and patient kidney function-related information. We present a case of a 47-year-old woman at Bethesda Hospital Yogyakarta with bilateral hydronephrosis accompanied by left pyonephrosis reviewed through radiological modalities such as Ultrasonography, MSCT, and X-ray.

Case Description: A 47-year-old woman presented to Bethesda Hospital Yogyakarta on June 4, 2021, complaining of left flank pain, nausea, vomiting, decreased appetite, accompanied by epigastric discomfort and a burning sensation in the mouth. The patient has a history of type 2 diabetes mellitus. Abdominal ultrasound showed dilation of the right kidney pelvicalyceal system, as well as lithiasis leading to hydronephrosis due to urolithiasis. Abdominal MSCT examination revealed dilation of the pelvicalyceal system with cystic structures in the right kidney. In contrast, the left kidney showed enlargement of the renal contour with cystic lesions, indicating grade IV hydronephrosis (pyonephrosis). Calcifications were also found in the proximal 1/3 and distal 1/3 of the left ureter. The patient underwent pyelolysis with bilateral DJ Stent placement confirmed by plain abdominal X-ray and received pharmacological antibiotic therapy.

Conclusion: Pyonephrosis is a rare condition resulting from an upper urinary tract infection involving obstruction and is a progression of hydronephrosis due to kidney stones.

 

Latar Belakang: Pyonefrosis merupakan progresi dari penyakit sebelumnya dan jarang terjadi pada orang dewasa, anak-anak dan sangat jarang pada neonates. Dalam sebuah penelitian ditemukan dari total 550 pasien dengan pyelonephritis, 10,9% diantaranya mengalami pyonefrosis. Modalitas utama yang biasanya digunakan adalah Utrasound dengan pertimbangan kenyamanan, biaya rendah, dan akurasi tinggi pada pasien yang dicurigai mengalami pyonefrosis. Pada modalitas lain dapat mengunakan CT-Scan yang dapat memberikan infromasi baik komponen dari hidronefrotik, penyebab, tingkat keparahan dan perluasan ke ekstrarenal hingga informasi terkait fungsi ginjal pasien. Kami memaparkan kasus wanita berusia 47 tahun di RS Bethesda Yogyakarta dengan hidronefrosis bilateral disertai pyonefrosis sinistra yang ditinjau melalui gambaran modalitas radiologi berupa Ultrasonografi, MSCT dan X-Ray.

Deskripsi kasus: Seorang wanita berusia 47 tahun datang ke Rumah Sakit Bethesda Yogyakarta pada 4 Juni 2021 dengan keluhan utama nyeri pinggang kiri, mual, muntah dan nafsu makan menurun disertai ulu hati dan mulut terasa terbakar. Pasien memiliki riwayat penyakit DM tipe 2. Hasil USG abdomen tampak sistem pelvico calyx ginjal kanan yang melebar, serta tampak lithiasis mengarah pada pada hydronefrosis akibat urolithiasis. Pemeriksaan MSCT Abdomen menunjukkan pelebaran dari sistem pelvico calyx dengan struktur kistik pada ginjal kanan, sedangkan pada ginjal kiri tampak pembesaran kontur ginjak dengan lesi kistik yang mengarah pada hidronefrosis grade IV (pyonefrosis).  Ditemukan juga adanya kalsifikasi pada 1/3 proksimal dan 1/3 distal ureter sinistra. Pasien mendapatkan tindakan pyelolutotomi dengan pemasangan DJ Stent bilateral yang terkonfirmasi dengan foto polos abdomen, dan terapi farmakologi antibiotik.

Kesimpulan: Pyonefrosis merupakan penyakit langka, penyakit ini merupakan akibat dari infeksi sistem saluran kemih bagian atas yang melibatkan obstruksi dan merupakan progresi dari hidronefrosis akibat batu ginjal.

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How to Cite

Bisay, V. A. P. ., & Sudharmadji. (2023). Pendekatan diagnosis dan imaging pyonefrosis et causa urolithiasis dengan hidronefrosis grade IV. Intisari Sains Medis, 15(1), 308–313. https://doi.org/10.15562/ism.v15i1.1957

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Vallentino Ardine Prasetya Bisay
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Sudharmadji
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