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[Emphysematous Pyelonephritis with Cardio-Pulmonary Arrest : A Case Report]
Gaku Yamamichi1, Koichi Tsutahara1, Sohei Kuribayashi1
1The Department of Urology, Osaka General Medical Center.
Hinyokika Kiyo. Acta Urologica Japonica
|September 15, 2016
Summary
A diabetic patient experienced cardiac arrest due to severe diabetic ketoacidosis and emphysematous pyelonephritis. Prompt nephrectomy and multidisciplinary care led to infection resolution.
Area of Science:
- Nephrology
- Endocrinology
- Infectious Diseases
Background:
- Untreated type II diabetes mellitus can lead to severe metabolic derangements.
- Emphysematous pyelonephritis is a rare, life-threatening renal infection characterized by gas in the kidney parenchyma.
Observation:
- A 40-year-old woman presented with cardiopulmonary arrest and ventricular fibrillation.
- Initial findings included extreme hyperglycemia (722 mg/dl) and severe metabolic acidosis (pH 6.704).
- Abdominal CT revealed gas within the left kidney parenchyma, consistent with emphysematous pyelonephritis.
Findings:
- The patient was diagnosed with emphysematous pyelonephritis and Escherichia coli sepsis.
- Emergency nephrectomy and broad-spectrum antibiotics (doripenem) were initiated.
- Necrosis of the small intestine necessitated surgical resection.
- Intensive management of hyperglycemia with intravenous insulin was crucial.
Implications:
- This case highlights the critical interplay between uncontrolled diabetes, severe infection, and multi-organ compromise.
- Multidisciplinary management is essential for survival in complex cases of emphysematous pyelonephritis.
- Prompt diagnosis and aggressive treatment, including surgical intervention and glycemic control, are vital.
