Massive hydropyonephrosis on pediatric patient: A case report of management and source control

Introduction and importance: Dilation and stretching of the collecting system of the kidney due to obstruction of urine flow is called hydronephrosis. This case may be accompanied by the presence of pus known as pyonephrosis. This case report reporting massive pyonephrosis in pediatrics related to management and source of control.

Case presentation: A 10-year-old boy came in with the main complaints of high fever, decreased appetite, vomiting, and nausea. The examination showed left severe hydronephrosis (+) with a size of 14.59 × 6.9 × 9.2 cm. The patient underwent percutaneous nephrostomy (PCN) and showed pus production. From the antegrade pyelography (APG) during PCN, it was stenosis of the left ureteropelvic junction (UPJ). Empirical antibiotics were administered, followed by albumin transfusion. Antibiotics were changed on day 3 post-PCN when urine culture results showed Staphylococcus aureus. After successful improvement of the general condition and minimal pus production from PCN, the patient had a Double J Stent (DJ) and pyeloplasty on the left UPJ. The patient was discharged on day 4 after the left pyeloplasty.

Clinical discussion: Management of UPJ Stenosis with massive hydronephrosis complications can be done in two stages with the first stage being the diversion of pus from the kidney, then followed by pyeloplasty management. Management is continued with nephrostomy or ureteral stent placement for urine diversion. Management of bacterial infections is adjusted according to culture results.

Conclusion: Management of hydronephrosis with pyonephrosis as complications can be be carried out in two stages, pus diversion, then followed by the pyeloplasty.