El-Hennawy Adel S, Kona Hima
Nephrology and Dialysis Center, Department of Medicine, Renal Division, Coney Island Hospital, Brooklyn, New York, USA.
Am J Ther. 2007 Nov-Dec;14(6):588-91. doi: 10.1097/MJT.0b013e3180ed8fd6.
Emphysematous pyelonephritis (EPN) is a serious and often life-threatening condition due to a gas-producing and necrotizing infection involving the renal parenchyma and perirenal tissue. The infection is almost exclusively seen in diabetic patients, and the main feature of its presence is finding gas within the kidney. Patients usually present with fever, chills, flank pain, and dysuria. Laboratory testing usually reveals hyperglycemia, leukocytosis, pyuria, an elevated blood urea nitrogen (BUN) level, and high serum creatinine level. Other, nonspecific symptoms such as abdominal pain, nausea, vomiting, and diarrhea can accompany acute pyelonephritis, as found in the reported case. The appropriate management of such serious infection requires combined medical and surgical treatment. In severe infection, nephrectomy should not be delayed. We report a case of EPN in a diabetic patient who presented with gastrointestinal symptoms. A high index of suspicion, coupled with a good imaging study [preferably computed tomography (CT) scanning] of the abdomen can lead to early diagnosis. Appropriate medical and surgical management have resulted in a successful outcome.
气肿性肾盂肾炎（EPN）是一种严重且常危及生命的病症，由产气并导致坏死的感染累及肾实质和肾周组织引起。这种感染几乎仅见于糖尿病患者，其主要特征是在肾脏内发现气体。患者通常表现为发热、寒战、胁腹痛和排尿困难。实验室检查通常显示血糖升高、白细胞增多、脓尿、血尿素氮（BUN）水平升高以及血清肌酐水平升高。其他非特异性症状，如腹痛、恶心、呕吐和腹泻，可能伴随急性肾盂肾炎出现，如本报告病例中所见。对于这种严重感染的恰当处理需要药物和手术联合治疗。在严重感染时，不应延迟肾切除术。我们报告一例患有胃肠道症状的糖尿病患者发生气肿性肾盂肾炎的病例。高度的怀疑指数，再加上对腹部进行良好的影像学检查[最好是计算机断层扫描（CT）]，可实现早期诊断。恰当的药物和手术处理已带来成功的结果。
