[Acute bilateral emphysematous pyelonephritis. A therapeutic challenge]

Area of Science:

• Nephrology
• Infectious Diseases
• Diabetology

Background:

• Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal infection caused by gas-forming bacteria, predominantly affecting diabetic patients.
• EPN is associated with high morbidity and mortality, often necessitating urgent surgical intervention like nephrectomy.

Observation:

• A 57-year-old female diabetic patient presented with septic shock and acute bilateral EPN, complicated by diabetic ketoacidosis.
• Blood and urine cultures identified Escherichia coli as the causative pathogen.
• The patient exhibited signs of severe infection and metabolic derangement.

Findings:

• The patient achieved a successful clinical recovery without requiring surgical intervention (nephrectomy) or urinary catheter drainage.
• Treatment consisted of long-term broad-spectrum antibiotics, meticulous diabetic control, and comprehensive supportive medical management.
• Conservative management proved effective in resolving this life-threatening condition.

Implications:

• This case suggests that a non-operative approach, including antibiotics and supportive care, can be a viable and successful strategy for managing EPN, even in critically ill patients.
• Optimizing glycemic control and providing aggressive supportive measures are crucial components in the management of EPN in diabetic patients.
• Highlights the importance of considering conservative management options before resorting to nephrectomy in select EPN cases.