Zhu Xiyan, Shu Hongyun, Han Sisi, Li Jianhong, Su Haicui, Li Qiaowen
Department of Cardiovascular Medicine, The Affiliated Qingyuan Hospital (Qingyuan People's Hospital), Guangzhou Medical University, Guangdong, China.
Institute of Gerontology, Guangzhou Geriatric Hospital, Guangzhou Medical University, Guangzhou, China.
Medicine (Baltimore). 2024 Nov 22;103(47):e40655. doi: 10.1097/MD.0000000000040655.
Acute myocardial infarction (AMI) is the leading global cause of death from cardiovascular disease, and the mortality rate increases in the presence of comorbidities such as renal abscess. The treatment of AMI combined with renal abscess is challenging, especially in combination with urinary tract obstruction, as percutaneous coronary intervention (PCI) can lead to progression of the renal abscess and deterioration of renal function. Currently, there is no consensus on the treatment of renal abscess in AMI.
We reported a case of a 74-year-old male patient with acute non-ST-segment elevation myocardial infarction combined with urinary tract obstruction. During his hospitalization, the hydronephrosis progressed to a renal abscess, which we punctured and drained. He ultimately underwent twice PCI and surgical relief of the ureteral obstruction shortly thereafter.
He was diagnosed with acute non-ST elevation myocardial infarction on admission, unfortunately, his hydronephrosis progressed into a renal abscess after the first PCI, which made further treatment difficult.
We performed 2 coronary angiography examinations and implanted a stent in the stenotic coronary artery during the second procedure, which was preceded by an aggressive regimen of antibiotics and puncture and drainage of the renal abscess, which set the stage for the second PCI.
We successfully performed coronary revascularisation to treat his coronary artery disease. One month later, his renal abscess drain was removed and the ureteral obstruction was finally resolved after undergoing percutaneous nephrolithotripsy for ureteral stone extraction.
The occurrence of renal abscesses is rare and may be unavoidable in those patients with preexisting structural lesions in the urinary tract where coronary angiography will increase the incidence of renal abscesses. Aggressive anti-infective therapy and drainage of pus by puncture will help the renal abscess to heal, and repeat coronary angiography has been shown to be safe in the meantime.
急性心肌梗死（AMI）是全球心血管疾病死亡的主要原因，在存在肾脓肿等合并症时死亡率会增加。AMI合并肾脓肿的治疗具有挑战性，尤其是合并尿路梗阻时，因为经皮冠状动脉介入治疗（PCI）可能导致肾脓肿进展和肾功能恶化。目前，对于AMI合并肾脓肿的治疗尚无共识。
我们报告了一例74岁男性患者，患有急性非ST段抬高型心肌梗死合并尿路梗阻。住院期间，肾积水进展为肾脓肿，我们对其进行了穿刺引流。此后不久，他最终接受了两次PCI，并进行了输尿管梗阻的手术解除。
入院时他被诊断为急性非ST段抬高型心肌梗死，不幸的是，首次PCI后他的肾积水进展为肾脓肿，这使得进一步治疗变得困难。
我们进行了2次冠状动脉造影检查，并在第二次手术中在狭窄的冠状动脉中植入了支架，在此之前进行了积极的抗生素治疗以及肾脓肿的穿刺引流，这为第二次PCI奠定了基础。
我们成功进行了冠状动脉血运重建以治疗他的冠状动脉疾病。1个月后，他的肾脓肿引流管被拔除，在接受经皮肾镜取石术以取出输尿管结石后，输尿管梗阻最终得以解决。
肾脓肿的发生很少见，在尿路已有结构病变的患者中可能不可避免，冠状动脉造影会增加肾脓肿的发生率。积极的抗感染治疗和穿刺排脓有助于肾脓肿愈合，同时重复冠状动脉造影已被证明是安全的。
