A case of emphysematous pyelonephritis in an older man with poorly controlled type 2 diabetes mellitus.

IF 1 Q4 UROLOGY & NEPHROLOGY
CEN Case Reports Pub Date : 2024-06-01 Epub Date: 2023-09-22 DOI:10.1007/s13730-023-00821-7
Mayuka Nishikawara, Makoto Harada, Daiki Yamazaki, Tetsuji Kakegawa, Koji Hashimoto, Yuji Kamijo
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Abstract

Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection characterized by gas retention and a poor prognosis. We present the case of a 75-year-old man who was diagnosed early with EPN and received multidisciplinary treatment. He had poorly controlled type 2 diabetes mellitus (DM) and chronic kidney disease (CKD), and was treated with oral hypoglycemic drugs, including a sodium-glucose co-transporter-2 inhibitor. He experienced the onset of back pain in the midsection of his back, tenderness in the costovertebral angle, and a high fever (> 39 °C), accompanied by tachycardia, hypotension, and tachypnea. The patient was diagnosed with pyelonephritis and septic shock. Immediate measures encompassing empirical antibiotic therapy, administration of noradrenaline, blood glucose regulation, and urethral catheterization were implemented. However, due to the persistent fever (> 38 °C) and lack of improvement in his condition, abdominal computed tomography (CT) was repeated on the fourth day. This revealed the presence of gas around the right kidney parenchyma, leading to a diagnosis of EPN that had evolved from acute pyelonephritis. Subsequently, percutaneous drainage of the right kidney parenchyma was performed. Subsequently, multidisciplinary treatment was continued, and his condition gradually improved. Clinicians should evaluate abdominal CT when acute pyelonephritis does not improve within a few days of antibiotic therapy. Disease progression from acute pyelonephritis to EPN should be considered in patients with DM and CKD.

一例老年男性2型糖尿病控制不佳的肺气肿性肾盂肾炎。
肺气肿性肾盂肾炎(EPN)是一种坏死性细菌感染,其特征是气体潴留,预后不良。我们报告了一例75岁的男性患者,他早期被诊断为EPN,并接受了多学科治疗。他患有控制不佳的2型糖尿病(DM)和慢性肾病(CKD),并接受了口服降糖药物治疗,包括钠-葡萄糖共转运蛋白-2抑制剂。他经历了背部中段的背痛、肋脊椎角的压痛和高烧(> 39°C),伴有心动过速、低血压和呼吸急促。病人被诊断为肾盂肾炎和感染性休克。实施了包括经验性抗生素治疗、去甲肾上腺素给药、血糖调节和导尿在内的即时措施。然而,由于持续发烧(> 38°C)并且他的病情没有改善,在第四天重复进行腹部计算机断层扫描(CT)。这揭示了右肾实质周围存在气体,从而诊断为由急性肾盂肾炎演变而来的EPN。随后,对右肾实质进行经皮引流。随后,多学科治疗继续进行,他的病情逐渐好转。当急性肾盂肾炎在抗生素治疗的几天内没有改善时,临床医生应该评估腹部CT。糖尿病和CKD患者应考虑从急性肾盂肾炎到EPN的疾病进展。
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来源期刊
CEN Case Reports
CEN Case Reports UROLOGY & NEPHROLOGY-
CiteScore
1.90
自引率
0.00%
发文量
80
期刊介绍: Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN).  The journal publishes original case reports in nephrology and related areas.  The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.
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