NDT Advance Access originally published online on August 5, 2006
Nephrology Dialysis Transplantation 2006 21(11):3331-3332; doi:10.1093/ndt/gfl462
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
(Section Editor: G. H. Neild)
Emphysematous pyelonephritis treated with percutaneous catheter drainage and antibiotics
1Department of Internal Medicine and 2Department of Radiology, Seoul National University Boramae Hospital, Seoul, Korea
Correspondence and offprint requests to: Yun Kyu Oh, MD, PhD, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, 425 Shindaebang 2-dong, Dongjak-gu, Seoul, 156-707, Korea. Email: yoonkyu{at}snu.ac.kr
Keywords: diabetes mellitus; emphysematous pyelonephritis; Escherichia coli; percutaneous drainage
A 58-year-old woman presented acutely with a 3-day history of general weakness, vomiting and fever. For 2 years she had had untreated diabetes mellitus. On examination she was ill, blood pressure was 64/47 mmHg, heart rate: 111 beats/min, respiration rate: 28/min and body temperature was 37.2°C. The right upper abdomen was tender. There was right loin tenderness.
Investigations: white blood cell count 10 380/mm3; haemoglobin 7.8 g/dl; haematocrit 23.1%; platelet count 36 000/mm3; blood urea nitrogen 70 mg/dl; serum creatinine 6.2 mg/dl; glucose 302 mg/dl; C-reactive protein 21.4 mg/dl; sodium 129 mEq/l; potassium 4.1 mEq/l; chloride 98 mEq/l; and total CO2 8.9 mEq/l. An arterial blood gas pH 7.242, pO2 60 mmHg, pCO2 22 mmHg and bicarbonate 9.3 mEq/l.
A plain abdominal film showed air density in the right pelvocalyceal system and upper ureter (Figure 1). Computed tomography (CT) of the abdomen without contrast confirmed the presence of air in the pelvicalyceal system and upper ureter of the enlarged right kidney (Figure 2).
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Six hours after admission, she became hypotensive and unconscious. She was intubated and ventilated. She received fluid resuscitation, emergency haemodialysis, and intravenous piperacillin and tazobactam. A percutaneous catheter was inserted into the pelvicalyceal system of the right kidney and drained turbid fluid. Blood and urine cultures grew Escherichia coli. The catheter was removed on day 12 because of disappearance of air in right excretory system at follow-up CT. Antibiotic therapy was continued for 4 weeks. She survived but did not recover renal function.
Discussion
Emphysematous pyelonephritis (EPN) is a rare and severe infection of the kidney and its surrounding areas, characterized by the presence of gas in the renal parenchyma, collecting system or perinephric tissue. It usually occurs in patients with diabetes mellitus or urinary tract obstruction. Because it has a life-threatening and fulminant course, immediate nephrectomy with appropriate antibiotic treatment should not be delayed [1,2]. Recent reports, however, suggest that percutaneous drainage results in a successful outcome in selected patients [3].
Conflict of interest statement. None declared.
References
- McHugh TP, Albanna SE, Stewart NJ. (1998) Bilateral emphysematous pyelonephritis. Am J Emerg Med 16:166–169.[CrossRef][Web of Science][Medline]
- Jain H, Greenblatt JM, Albornoz AM. (2001) Emphysematous pyelonephritis: a rare cause of pneumaturia. Lancet 357:194.[CrossRef][Web of Science][Medline]
- Huang JJ and Tseng CC. (2000) Emphysematous pyelonephritis. Arch Intern Med 160:797–805.
[Abstract/Free Full Text]
Accepted in revised form: 13. 7.06
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