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UROLOGICAL IMAGES
Year : 2020  |  Volume : 36  |  Issue : 1  |  Page : 67-68
 

Gas-containing renal stones


Department of Genitourinary Surgery, Government Medical College, Kottayam, Kerala, India

Date of Submission04-Oct-2019
Date of Acceptance01-Dec-2019
Date of Web Publication2-Jan-2020

Correspondence Address:
Suresh Bhat
Department of Genitourinary Surgery, Government Medical College, Kottayam, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_271_19

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   Abstract 

Gas-containing renal stones is a rarely described complication of emphysematous pyelonephritis. Most of these patients are diabetic and almost all have urinary obstruction and stasis. Management of these patients may be associated with several complications.



How to cite this article:
Peter J, Bhat S, Paul F. Gas-containing renal stones. Indian J Urol 2020;36:67-8

How to cite this URL:
Peter J, Bhat S, Paul F. Gas-containing renal stones. Indian J Urol [serial online] 2020 [cited 2020 Apr 9];36:67-8. Available from: http://www.indianjurol.com/text.asp?2020/36/1/67/274697



   Introduction Top


Gas-containing renal stones is a rare sequel of serious renal infections, often linked with emphysematous pyelonephritis[1] due to gas-producing organisms such as  Escherichia More Details coli or Klebsiella.[2] Majority of the patients are diabetic and have obstructive uropathy. So far, only 11 cases have been reported.


   Case Report Top


A 68-year-old male presented with left flank pain, fever, breathlessness, and oliguria. His medical history included coronary artery disease, hypertension, and left hemiparesis. Urine microscopic examination showed Gram-negative bacteria. Urine culture grew E. coli. Creatinine was 3.7 mg/dL. Ultrasonography revealed moderate left hydroureteronephrosis and perinephric collection with multiple calculi in the renal pelvis and lower pole. X-ray kidney, ureter, and bladder revealed a staghorn calculus containing gas, involving the entire left pelvicalyceal system [Figure 1]. Noncontrast computed tomography scan confirmed left-sided staghorn calculus containing gas with perinephric collection [Figure 2]. The patient underwent percutaneous surgery for stone removal. The stone culture grew Klebsiella.
Figure 1: X-ray kidney, ureter, and bladder showing gas-containing left staghorn calculus

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Figure 2: Noncontrast computed tomography kidney, ureter, and bladder showing gas inside the left renal calculus (white arrow mark)

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   Discussion Top


Gas-containing renal stones are usually associated with emphysematous pyelonephritis by gas-producing organisms. Seven out of eleven cases reported had E. coli infection in urine, whereas two had Klebsiella and one had Staphylococcus infection. E. coli can ferment sugars, particularly glucose. E. coli is also isolated from the renal calculi. Electron microscopy or culture of stones showed a much higher rate of infection than urine culture.[3]

Intracalculus metabolism by the bacteria is the main mechanism producing gas inside the stone. In most of the reported cases, the stone was infected with E. coli. E. coli is the most common gas-producing organism. Gases liberated due to rapid catabolism of tissues are also contributory.[2] Gases produced in emphysematous pyelonephritis may be entrapped within the stones during its formation. On analysis of emphysematous pyelonephritis cases, the gases isolated included 4.1% carbon di oxide, 10.5% oxygen, 67.3% nitrogen, and 18.1% unknown gases.

Presence of gas inside the stones illustrates a combination of two pathologies, namely metabolic activity of the bacteria inside the stone and tissue metabolism.[4] Urinary stasis likely decreases the renal perfusion, impairing the washout of formed gases, and also promotes stone formation and aggregation.

Gas-containing renal stones is a fatal sign.[5] These patients usually develop serious complications such as septicemia and septic shock and even deaths have been reported in them.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


   Conclusion Top


Gas-containing renal stones is a rare complication of emphysematous pyelonephritis. It is associated with urinary stasis and diabetes and hence may lead to perioperative sepsis and death. Gas-containing renal stones is a harbinger of mortality.

Financial support and sponsorship:

Nil.

Conflicts of interest:

There are no conflicts of interest.

 
   References Top

1.
Rapoport MJ, Sadah AY. Gas-containing renal stones. Urology 2006;68:890.e13-5.  Back to cited text no. 1
    
2.
Yang WH, Shen NC. Gas-forming infection of the urinary tract: An investigation of fermentation as a mechanism. J Urol 1990;143:960-4.  Back to cited text no. 2
    
3.
Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: A prospective clinical study. J Urol 2005;173:1610-4.  Back to cited text no. 3
    
4.
Simpson AD, Rytina ER, Ball RY, Gaches CG. 'Stones, gas and gaiters': Gas-filled matrix calculi of the renal pelvis. Br J Urol 1998;81:770-2.  Back to cited text no. 4
    
5.
Durhan G, Ayyildiz V, Özmen M, Akata D. Gas containing renal stone, a fatal sign. CausaPedia 2015;4:1188.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures

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