Blood pressure (BP) abnormalities are clues to make differential diagnosis and prognostic indicators in various renal diseases in the emergency department (ED), arising from and contributing to kidney dysfunction via activation of the renin-angiotensin-aldosterone system, impaired perfusion, volume overload in chronic kidney disease (CKD) patients, inflammatory processes, and traumatic structural injury. This narrative review summarizes BP patterns and pathophysiology across common renal conditions in the ED, including acute kidney injury, CKD, end-stage renal disease, glomerulonephritis, renal trauma, pyelonephritis, renal artery stenosis, nephrolithiasis, renal infarction, and renal tubular acidosis. Distinct BP profiles are observed: Hypotension often indicates prerenal, septic, or shock-associated acute kidney injury, severe infection, trauma, or shock, while hypertension predominates in CKD, end-stage renal disease, and ischemic or obstructive conditions due to renin-angiotensin-aldosterone system activation and sodium retention. Some disorders show variable BP patterns depending on stages, severity, and comorbidities. Overall, BP abnormalities provide valuable diagnostic and management guidance. Recognizing these predictable hemodynamic responses supports timely diagnosis, risk stratification, and targeted ED management.

Bilateral adrenal infarction in pregnancy is a rare but potentially life-threatening condition that can lead to acute adrenal insufficiency and is often misdiagnosed due to nonspecific symptoms. We report a 25-year-old primigravida at 34 weeks presenting with abdominal and lumbar pain, fever, and vomiting, initially treated as acute pyelonephritis. Clinical deterioration with tachypnea and metabolic acidosis prompted further investigations. Computed tomography pulmonary angiography ruled out pulmonary embolism, while contrast-enhanced abdominal computed tomography revealed bilateral non-enhancing adrenal enlargement. Serum cortisol was inappropriately low (128.2 nmol/L), supporting acute adrenal insufficiency. Immediate intravenous hydrocortisone and therapeutic anticoagulation led to rapid improvement. The patient delivered vaginally at 38 weeks under epidural analgesia with stress-dose corticosteroids. This case highlights the importance of early imaging and prompt corticosteroid therapy in pregnant patients with unexplained persistent abdominal pain.

Acute pyelonephritis is an infection of the kidney that affects both adult and pediatric populations. We describe the case of a 31-year-old mother and her infant boy diagnosed with pyelonephritis due to the same organism. Both patients harbored risk factors that increased their susceptibility to infection; however, more importantly, maternal-to-neonatal transmission of microbiota is thought to play a large role in the neonate's infection. This case highlights the importance of and the clinical implications of maternal and neonatal microbiomes.

Background Urological disorders are important differential diagnoses in patients presenting with an acute abdomen to a general surgical emergency unit. Conditions such as ureteric colic, obstructive uropathy, acute pyelonephritis, urinary retention, renal trauma, and testicular torsion may simulate appendicitis, intestinal obstruction, biliary colic, or perforation peritonitis. This clinical overlap may delay correct diagnosis, particularly when urinary symptoms are subtle or absent. This study aimed to assess the pattern of urological conditions mimicking acute abdomen and the diagnostic difficulties encountered during initial surgical evaluation. Materials and methods This hospital-based observational study included patients who presented with acute abdominal pain to the general surgery emergency department and were later confirmed to have a urological cause. Data regarding age, sex, presenting symptoms, initial clinical impression, urine findings, renal function tests, ultrasonography, computed tomography findings, final diagnosis, treatment given, and outcome were recorded and analyzed. Results A total of 80 patients were included. Most patients were male subjects (n=56; 70%), and the commonest age group was 31 to 50 years (n=34; 42.5%). Acute abdominal pain was present in all patients, followed by vomiting 42.5%, fever 32.5%, dysuria 28.8%, flank pain 45.0%, and hematuria 21.3%. The most frequent urological cause was ureteric calculus with ureteric colic (n=36; 45.0%), followed by acute pyelonephritis (n=14; 17.5%), obstructive uropathy (n=11; 13.8%), acute urinary retention (n=8; 10.0%), renal or ureteric trauma (n=6; 7.5%), and testicular torsion presenting as lower abdominal pain (n=5; 6.2%). At first assessment, 31 (38.8%) patients were suspected to have a primary general surgical condition. Ultrasonography supported the diagnosis in 58 (72.5%), while computed tomography was required in 29 (36.3%) patients. Conservative treatment was sufficient in 44 (55%) patients and 36 (45%) required urological intervention. Conclusion Urological emergencies can closely resemble acute surgical abdomen. Careful urinary history, focused examination, urine analysis, renal function assessment, ultrasonography, and selective computed tomography help in early diagnosis and prevent unnecessary surgical intervention.

Emphysematous pyelonephritis (EPN) is a rare, life-threatening renal infection that is often associated with diabetes. This report describes a 59-year-old woman with neglected untreated type 2 diabetes who developed EPN caused by Escherichia coli and was complicated by sepsis and acute kidney injury (AKI). Unfortunately, the patient's condition deteriorated despite prompt conservative management with antibiotics, ureteral stenting, and strict glycemic control, as shown by imaging studies. Ultimately, laparoscopic right nephrectomy was performed, resulting in a clinical improvement and recovery. This case indicates that conservative management may fail even in lower-class EPN, particularly when risk factors such as thrombocytopenia and AKI are present.

Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection that can affect the renal parenchyma, collecting system, or perinephric tissue. Although typically caused by enteric Gram-negative bacteria, infections secondary to Candida occur rarely. We present the case of a 72-year-old female who was transferred from an outside hospital with a chief complaint of abdominal pain in the setting of dislodged percutaneous nephrostomy tube for chronic hydronephrosis. Clinically, she presented without evidence of septic shock but was found to have elevated creatinine (6.04), concerning for acute renal failure. Urology was consulted and performed cystoscopy that showed a large bilateral mass consistent with fungal ball formation. Subsequent urine cultures speciated Candida tropicalis and Candida glabrata. Per infectious disease recommendations, the patient was initially started on treatment with fluconazole and flucytosine; however, fluconazole was switched to amphotericin B deoxycholate after sensitivities reported resistance to fluconazole for Candida tropicalis. Additionally, urology performed a bilateral percutaneous nephroscopy with ultrasonic lithotripsy for removal of her fungal bezoar on Day 22 of her hospitalization with subsequent nephrostograms that showed a patent genitourinary system. This case demonstrates successful treatment of EPN secondary to azole-resistant Candida species using combined systemic antifungal therapy and an endourologic approach. This avoided the use of percutaneous nephrostomy irrigation with amphotericin deoxycholate as recommended in current guidelines and prevented potential complications this procedure carries.

There are various radiopharmaceuticals and hybrid imaging techniques for evaluating pediatric patients in the acute care setting. The focus of this article is on common nuclear medicine applications in pediatric acute care. Brain scintigraphy is an important ancillary test for evaluation of brain death/death by neurologic criteria when the clinical examination or apnea test cannot be safely or completely performed. Ventilation-perfusion scintigraphy is considered as a safe and useful test for suspected pulmonary embolism in hemodynamically stable children, especially when the chest radiograph is normal or near normal and radiation reduction is important. 99mTc-pertechnetate scintigraphy is stated to be the best noninvasive nuclear medicine test for detecting ectopic gastric mucosa in Meckel's diverticulum, whereas 99mTc-labeled red blood cell scintigraphy is useful for evaluating active or intermittent lower gastrointestinal bleeding from different causes. Hepatobiliary scintigraphy provides functional assessment of biliary excretion and is useful for evaluation of acute cholecystitis, choledochal cysts, and bile leaks. 99mTc-DMSA renal cortical scintigraphy is a sensitive method for detecting acute pyelonephritis and renal cortical scarring, while 99mTc-MAG3 renal scintigraphy is used to evaluate early and late complications of renal transplantation. Bone scintigraphy is considered as a valuable imaging modality for evaluation of osteomyelitis, occult fracture, stress injury, sickle cell related bone pain, and selected cases of suspected physical abuse, especially when whole body assessment is needed. 18F-FDG PET/CT has an increasing role in selected children with fever of unknown origin and inflammatory disorders. Moving forward, continued refinement of pediatric administered activities, wider use of SPECT/CT and PET-based imaging and updated pediatric-specific guidelines are expected to further improve the role of nuclear medicine in acute pediatric care.

Epidural blood patch (EBP) is considered the most effective interventional treatment for post-dural puncture headache (PDPH), but it is considered a relative contraindication during active bacteraemia because of the theoretical risk of neuraxial seeding. We describe a 26-year-old primiparous woman who developed a typical orthostatic headache after a technically difficult labour epidural analgesia. On postpartum day 4, she developed fever and urinary symptoms; blood and urine cultures grew Escherichia coli, and abdominal imaging subsequently confirmed acute right pyelonephritis with bacteraemia. Brain magnetic resonance imaging (MRI) with venographic sequences excluded cerebral venous sinus thrombosis and other intracranial pathology. After multidisciplinary discussion, we performed bilateral transnasal sphenopalatine ganglion block followed by bilateral ultrasound-guided greater occipital nerve block on postpartum day 6. Headache severity decreased from a numerical rating scale (NRS) of 7/10 to 2/10 within 30 minutes, and the patient was able to resume care of her newborn. She remained symptom-free at hospital discharge and at telephone follow-up 7 and 30 days later. This case supports peripheral nerve blocks as a minimally invasive bridge therapy for PDPH when EBP is contraindicated, deferred or declined, and adds to the limited literature on documented obstetric bacteraemia.