Abstract

DELLAVEDOVA, Tristán et al. Emphysematous pyelonephritis: Case report. Arch. Esp. Urol. [online]. 2009, vol.62, n.5, pp.406-409. ISSN 0004-0614.

Objective: To describe an unusual case of emphysematous pyelonephritis, a disease with high morbidity and mortality. Methods: We present the case of a 62-year old diabetic female with history of kidney stones, who consulted for fever, left lower-back pain and impairment of the general condition. Abdominopelvic computed tomography revealed a perinephric collection of air reaching the abdominal wall. Results: After initial medical management with antibiotics and general supportive measures, we performed an open incision and drainage. A week later, signs of sepsis reappeared and the left kidney was excised. The patient died two weeks later of septic shock. Conclusions: This disease must be suspected in diabetic females with renal lithiasis and pyelonephritis not responding to treatment, and impaired general condition. Early diagnosis (computed tomography is the gold-standard) and supportive measures are essential for initial management. Surgery can be open (drainage, initial or deferred nephrectomy), percutaneous (nephrostomy) or endoscopic (double-J stent). Conservative management is a choice in bilateral or mild cases. Mortality rate is high and worsens with delayed therapy.

Keywords : Pyelonephritis; Emphysematous pyelonephritis; Complicated urinary tract infection; Urosepsis; Diabetes mellitus.

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