A CASE OF SEVERE BILATERAL EMPHYSEMATOUS PYELONEPHRITIS
Dr SAMUEL PACK, DR ANDREA HUANG1, DR GOVIND NARAYANAN1
1Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia, Liverpool, Australia
Background: Emphysematous pyelonephritis (EPN) is a gas-producing infection of the collecting system, renal parenchyma and perirenal area associated with mortality rates up to 42%. Risk factors include diabetes, urinary tract obstruction and immunosuppression. Management ranges from minimally invasive options, such as intravenous antibiotics and percutaneous drainage to invasive emergency nephrectomy. A number of classification systems exist, including both clinical and radiological features, however a unified approach to classification and management remains elusive.
Case Report: We present a case of a 43-year-old male who presented with septic shock secondary to severe left sided EPN in the context of recent admission for Klebsiella aerogenes urinary tract infection (UTI) and urinary retention. Computed tomography (CT) imaging was notable for diffuse parenchymal emphysema involving the left kidney, urinary bladder and subsequently the right kidney.
He had a background of alcohol related type 3c diabetes mellitus with endocrine and exocrine insufficiency. He was also severely cachectic with a body mass index of 15.
He was treated with broad spectrum antibiotics and underwent emergency left nephrectomy. His admission was complicated by disseminated intravascular coagulation, severe acute kidney injury needing dialysis and transient small bowel obstruction from Superior Mesenteric Artery syndrome. Despite these measures, he developed end stage renal failure with ongoing requirement for haemodialysis.
Conclusion: EPN is an uncommon complication of UTI predominantly occurring in the diabetic population. There has been a recent trend towards minimally invasive management, however emergency nephrectomy is sometimes required in severe cases and overall mortality remains high.
This case report is significant for the degree of emphysema shown on CT imaging and demonstrates the potential complications in EPN and the importance of early recognition and management.
Biography:
Samuel is a Resident Medical Officer currently working in South Western Sydney. He graduated from Notre Dame Sydney Medical School in 2022. Prior to this he worked as a Mechanical Engineer in the Oil and Gas Industry. He has a strong interest in renal medicine and wishes to pursue a career as a physician in the future.