The conservative management of Corynebacterium group D2 encrusted pyelitis

Objective To evaluate the conservative management of encrusted pyelitis (EP ), an infectious disease caused by urea-splitting micro-organisms (Coryneba cterium group D2 being the most common), and characterized by stone encrust ation of the collecting system. Patients and methods Four patients (aged 17-62 years) with EP caused by Cor ynebacterium group D2 were treated conservatively with intravenous vancomyc in and percutaneous acidification of the renal collecting system. Percutane ous nephrostomy tubes were placed to allow irrigation with Thomas' acid sol ution, the outflow being ensured by ureteric catheters. Patients were monit ored and the results of and tolerance to treatment evaluated clinically, by biological assays, and by imaging techniques (ultrasonography, computed to mography and pyelography), Results No kidneys were lost and in all patients with initial renal failure , creatinine levels recovered to previous values. The adverse effects were moderate, consisting of flank pain or discomfort, and low-grade fever. Thre e patients developed asymptomatic fungal urinary tract infections requiring antifungal agents. The encrustations were treated effectively and almost d isappeared in two patients, while the other two had no residual calcificati on, One transplanted-kidney recipient developed a ureteric stricture requir ing surgical repair. Within a mean follow-up of 16 months, there was no rec urrence of EP and the residual encrustation remained small. Conclusion The conservative treatment of EP can avoid surgery in many cases , although there are some adverse effects of irrigation. The long-term foll ow-up and prevention of recurrent EP are nevertheless required.