Issue: Vojnosanit Pregl 2017; Vol. 74 (No. 12)
Emphysematous pyelonephritis – case report and review of literature
Authors:
Dejan Ćelić, Dušan Božić, Kosta Petrović, Srdjan Živojinov, Tatjana Djurdjević Mirković, Milica Popović
Introduction. Emphysematous pyelonephritis (EPN) is a severe,potentially fatal necrotizing infection of the kidney with
the clinical picture ranging from the mild abdominal pain and
discomfort to the septic shock and multiorgan failure. We presented
here a case of EPN in a poorly controlled diabetic patient
that was the first registered case of EPN in our clinic for
more than ten years. Case report. A 78-year-old diabetic male
patient was referred to the Clinic for Nephrology and Clinical
Immunology of the Clinical Center of Vojvodina, Novi Sad,
Serbia, with weakness, malaise, abdominal discomfort and reduced
daily urine volume. After complete physical exam, laboratory
work up, echosonographic and computed tomography
scanning we diagnosed the patient with EPN class IV, according
to the Huang and Tseng classification, with the presence of
5 risk factors for mortality (systolic blood pressure below 90
mmHg, altered consciousness, thrombocytopenia, elevated serum
creatinine level, bilateral disease). Treatment with conservative
therapy and percutaneous drainage was not successful,
further deteorioration of the patient status ensued so the patient
passed away on the 8th day of hospitalization due to the
development of septic shock with multiorgan failure that was
refractory to all measures that were instituted. Conclusion.
EPN is a severe, potentially fatal necrotizing inflammation of
the kidney and surrounding tissue. Management and prognosis
of this disease depends on the clinical status, risk factors and
radiological classification of the disease.
