Abstract

Emphysematous pyelonephritis is a life-threatening infection especially seen in patients with poorly-controlled diabetes mellitus. Imaging modalities (preferably computed tomography) are required to establish the diagnosis. Treatment modalities include volume resuscitation, broad-spectrum antibiotics, percutaneous drainage, and, as a last resort, nephrectomy. We present a case of a 46-year-old female who had hypertension and type-2 diabetes mellitus and presented with complaints of dysuria, back pain, and decreased urine output. Renal ultrasound and abdominal computerized tomography (CT) revealed air-fluid levels at each perirenal region and collecting systems, consistent with emphysematous pyelonephritis. Her clinical situation improved with vigorous fluid resuscitation and broad-spectrum antibiotic treatment.

Key Points

* Emphysematous pyelonephritis is a severe, potentially fatal necrotizing infection of renal parenchyma and perirenal tissues with gas-forming bacteria.

* More than 90% of cases occur in diabetics with poor glycemic control. Other predisposing factors are urinary tract obstruction, polycystic kidneys, end stage renal disease, and immunosuppression.

* Most of the time, imaging modalities, preferentially computed tomography, are needed to ascertain the diagnosis.

* Treatment depends on the severity of the disease. In its mildest forms, broad spectrum antibiotics along with vigorous hydration are appropriate treatment measures. In more severe cases, percutaneous drainage and medical therapy are appropriate. In the most severe cases, bilateral nephrectomy is performed as a last resort.