Pagnoux C, Cazaala J B, Méjean A, Haas C, Brochen J, Boitard C, Timsit J
Unité de diabétologie, service d'immunologie clinique, hôpital Necker-Enfants-Malades, Paris, France.
Rev Med Interne. 1997;18(11):888-92. doi: 10.1016/s0248-8663(97)81963-7.
Emphysematous pyelonephritis is a rare, life-threatening complication of upper urinary tract infections, characterized by the presence of gas in renal parenchyma and perirenal space. It occurs in 90% of cases in diabetic patients and E coli is the most common causative germ. The pathogenesis probably involves several factors including enhanced proliferation of microorganisms due to altered immune defences, mixed acid fermentation of glucose leading to gas production, and decreased elimination of the gas because of impaired tissue perfusion. Diagnosis is often delayed because the symptoms may be non-specific, as illustrated by the two cases we report herein. In patients with diabetes and febrile urinary tract infection, obstruction of the urinary tract should first be eliminated by echography. Then, if the infection does not rapidly respond to antimicrobial therapy, a scan should be performed. Aggressive management including correction of hemodynamics, parenteral antimicrobial therapy, and diabetes control with insulin therapy is mandatory, but a surgical procedure (nephrectomy or drainage) is almost always required.
气肿性肾盂肾炎是上尿路感染一种罕见的、危及生命的并发症，其特征是肾实质和肾周间隙存在气体。90%的病例发生在糖尿病患者中，大肠杆菌是最常见的致病病菌。发病机制可能涉及多个因素，包括由于免疫防御改变导致微生物增殖增强、葡萄糖混合酸发酵导致气体产生以及由于组织灌注受损导致气体清除减少。诊断往往延迟，因为症状可能不具特异性，如我们在此报告的两个病例所示。对于糖尿病和发热性尿路感染患者，应首先通过超声检查排除尿路梗阻。然后，如果感染对抗菌治疗没有迅速反应，应进行扫描。积极的治疗包括纠正血流动力学、胃肠外抗菌治疗以及用胰岛素治疗控制糖尿病，但几乎总是需要进行外科手术（肾切除术或引流术）。
