Case Summary
In this case, an older woman with a past medical history of kidney stones developed a severe kidney infection. According to the complaint, a KUB (Kidney, Ureter, and Bladder) x-ray was not performed. As a result of the delay in treatment, the patient developed life-threatening sepsis. Her hands became gangrenous as well. Consequently, both of her hands required amputation to save her life. Prosthetics have been ineffective due to the patient’s advanced age. She will require 24-hour care for the remainder of her life.
Case Theory
There is a strong correlation between sepsis and kidney disease. The risk of causing one increases with the risk of causing the other. The infection caused by a kidney stone can easily spread and cause sepsis or shut down vital organs. Any delay in treating kidney stone patients increases their morbidity and mortality rate. In the absence of aggressive and proper treatment, kidney stones can quickly become life-threatening.
Sepsis is the body’s life-threatening immune response to infection. It’s a medical emergency that requires immediate detection and treatment. An infection anywhere in the body can cause septic shock. It is, however, more common in pneumonia and urinary tract infections. Patients with kidney stones are commonly affected by sepsis. The mortality rate of patients with sepsis is approximately one-third. Many sepsis survivors experience life-changing sequelae including emotional trauma, chronic pain, fatigue, organ dysfunction, and amputations.
In a patient with a previous history of kidney stones, the failure to perform KUB x-rays and the delay in diagnosing the stones were below the standard of care. Physicians perform KUB x-rays to evaluate the abdominal area for causes of abdominal pain or to assess the urinary and gastrointestinal systems. KUB x-rays are typically the first diagnostic test used to evaluate the urinary system, particularly in patients who have a history of kidney disease. The clinical judgment of the treating physician is necessary regardless of the diagnostic test result in patients who demonstrate signs of infection. The failure to timely identify and treat kidney stones in this case resulted in acute sepsis, which was responsible for the amputation of both hands in the patient.
Expert Witness Specialities
Urology
An expert in urology can speak to the importance of the accurate and timely diagnosis of kidney stones and infections. The urology expert can opine on the standard of care for an elderly patient with a past medical history of kidney stones. The expert can also address whether immediate, proper treatment could have prevented renal sepsis and amputation.
Questions for Expert Witnesses
- How might a failure to appropriately manage kidney stones result in renal sepsis?
- What is the standard of care for ruling out infection in an older patient with a past medical history of kidney stones?
- Would immediate treatment have likely changed the prognosis and avoided amputation?
Expert Witness Involvement
Here is what the urology expert in this case had to say:
Expert Witness Response E-097077
I see patients with kidney stones in my daily practice. If unrecognized and not treated appropriately, a kidney stone can result in renal failure and infection.
