Nephrostomy for pyonephrosis

Case contributed by Dr Ian Bickle

Presentation

Single functioning kidney with ureteric stent. Worsening renal function and hydronephrosis.

Patient Data

Age: 40 years
Gender: Female
X-ray

Disparity in the size of the kidneys. Atrophic on the right and enlarged on the right.  Both contain renal calculi.

Left sided ureteric stent.

Ultrasound

Hydronephrosis, with layering of debris in the middle and lower pole calyces.

Left sided hydronephrosis despite ureteric stent in situ.  The upper ureter is thickened.

Bilateral renal calculi. Atrophic right kidney.

Fluoroscopy

Nephrostomy performed. The locking 8F drain prior to insertion.

Photo

Sample from the renal collecting system after puncture.

Content from the left renal collecting system - murky appearances of pus and urine mixed together.  Sent for microbiological analysis.

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