Kawaguchi Makoto, Kuroda Kenji, Yagi Kota, Kitamura Yosuke, Kawamura Kazuki, Ojima Kenichiro, Asakuma Junichi, Asano Tomohiko, Shinmoto Hiroshi, Ito Keiichi
Department of Urology, National Defense Medical College Hospital.
Department of Radiology, National Defense Medical College Hospital.
Nihon Hinyokika Gakkai Zasshi. 2019;110(2):134-137. doi: 10.5980/jpnjurol.110.134.
We report a case of a 53-year-old woman with emphysematous pyelonephritis who presented the preservation of the ipsilateral kidney following open drainage. She was transferred to our hospital with chief complaints of right back pain and high fever. On diagnosis, diabetes mellitus and a stone in the right ureter were confirmed, and she was followed up at a local clinic. Computed tomography revealed the presence of gas in the right renal pelvis, and the stone led to right hydronephrosis. Additionally, her hemoglobin A1c level was 11.3%. Hence, we diagnosed the patient with emphysematous pyelonephritis. Although right percutaneous nephrostomy was performed immediately after her admission, the gas in the right renal pelvis extended to the renal parenchyma one day later. Therefore, we performed open drainage of the right kidney to control severe inflammation. The gas disappeared after the procedure, and her systemic status gradually improved. We hypothesize that emphysematous pyelonephritis is treated with open drainage instead of nephrectomy while preserving the ipsilateral kidney.
我们报告一例53岁患有气肿性肾盂肾炎的女性患者，其在开放性引流后同侧肾脏得以保留。她因右侧背痛和高热为主诉被转诊至我院。诊断时，确诊患有糖尿病和右侧输尿管结石，她曾在当地诊所接受随访。计算机断层扫描显示右侧肾盂内存在气体，结石导致右侧肾积水。此外，她的糖化血红蛋白水平为11.3%。因此，我们诊断该患者患有气肿性肾盂肾炎。尽管患者入院后立即进行了右侧经皮肾造瘘术，但一天后右侧肾盂内的气体蔓延至肾实质。因此，我们对右侧肾脏进行了开放性引流以控制严重炎症。术后气体消失，她的全身状况逐渐改善。我们推测气肿性肾盂肾炎在保留同侧肾脏的情况下，采用开放性引流而非肾切除术进行治疗。
