Percutaneous nephrostomy

76 year old male presented with complaints on abdominal pain, nausea and fever. In ER he was found to be hypotensive (low blood pressure) with blood pressure in the 60’s. The analysis of his urine revealed evidence of the urinary tract infection (UTI). Blood and Urine cultures were obtained and the patient was admitted to ICU. Central venous catheter was placed. The patient developed acute renal failure due to acute tubular necrosis (ATN). ATN is an ischemic injury to the kidneys due to a low perfusion pressure.

Infection in the urinary tract is very common. Sometimes, patients present in Sepsis and septic shock (low blood pressure due to sepsis). The patient can also develop multiple organ failure including respiratory failure and kidney failure.

It is always important to determine the cause of the infection. Obstruction of the urinary flow from one or both kidney could precipitate infection and kidney failure. The obstruction could be due to a stone lodged in the ureter or an external mass compressing the ureters.

The patient above had an evidence of a hydronephrosis on the CT scan.
Percutaneous (through the skin) nephrostomy tube was place to “decompress” the kidney.
The image above demonstrates the catheter insertion into the kidney (nephrostomy).