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[Emphysematous pyelonephritis in diabetics]

C Pagnoux1, J B Cazaala, A Méjean

  • 1Unité de diabétologie, service d'immunologie clinique, hôpital Necker-Enfants-Malades, Paris, France.

La Revue De Medecine Interne
|January 1, 1997
PubMed
Summary

Emphysematous pyelonephritis, a severe kidney infection with gas, predominantly affects diabetic patients. Early diagnosis and aggressive treatment, including antibiotics and often surgery, are crucial for survival.

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Area of Science:

  • Nephrology
  • Infectious Diseases
  • Diabetology

Background:

  • Emphysematous pyelonephritis is a rare, life-threatening complication of upper urinary tract infections.
  • It is characterized by gas in the renal parenchyma and perirenal space, predominantly seen in diabetic patients (90%).
  • Escherichia coli is the most common causative pathogen.

Observation:

  • Pathogenesis involves enhanced microbial proliferation, glucose fermentation producing gas, and impaired gas elimination due to poor tissue perfusion.
  • Diagnosis can be delayed due to non-specific symptoms.
  • Echography is recommended to rule out urinary tract obstruction in diabetic patients with febrile urinary tract infections.

Findings:

  • If infection doesn't respond to antibiotics, a CT scan is indicated.

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  • Aggressive management is mandatory, including hemodynamic support, parenteral antibiotics, and insulin therapy for diabetes control.
  • Surgical intervention, such as nephrectomy or drainage, is almost always required.

    • Implications:

    • Prompt diagnosis and aggressive, multidisciplinary management are essential for improving outcomes in emphysematous pyelonephritis.
    • Understanding the pathogenesis aids in early recognition and treatment strategies.
    • This condition highlights the critical need for vigilant monitoring of urinary tract infections in diabetic patients.