Endocrine Abstracts

Introduction

Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma which occurs preferentially in diabetics and is fraught with heavy mortality. Adequate therapeutic management is controversial: medical or surgical, conservative or radical. We report two observations of emphysematous pyelonephritis in two female diabetic patients, aged 58 and 50 years old, respectively.

Observation

The symptoms were similar for both patients: fever, lower back pain, renal angle tenderness, dysuria, hyperglycemia and ketonuria. Blood tests indicated an inflammatory syndrome, acute renal failure and diabetic ketoacidosis. The urinalysis revealed pyuria, leukocyturia and a varied bacterial flora. The urine’s culture of the first patient yielded a growth of Candida whereas E.coli was isolated in the second patient. In both cases, renal ultrasound showed uretero-pelvic dilation upstream of a stone embedded in the meatus and CT-scan confirmed the diagnosis of EPN. The outcome of conservative management was different for both patients. The first patient was successfully treated with conservative management using broad-spectrum antibiotic and percutaneous drainage. However, despite percutaneous drainage and antibiotic therapy, subsequent nephrectomy was required for the second patient as she presented a septic shock. The outcome was favorable in both cases after conservative management in the first case and radical management in the second case.

Conclusion

EPN is a life-threatening infection that should be suspected in any diabetic with severe acute pyelonephritis resistant to medical treatment. In case of failure of conservative treatment, nephrectomy should be considered.