EMPHYSEMATOUS PYELONEPHRITIS A CASE REPORT AND REVIEW OF THE LITERATURE
Comparative Study with Japan and Other Countries
1989 Volume 80 Issue 2 Pages 279-284
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1989 Volume 80 Issue 2 Pages 279-284
A 36-year-old woman with diabetes mellitus complained of left flank pain and high fever. Drip infusion pyelogram (DIP) did not visualize the left kidney, but revealed crescent-shaped gas formation within the left renal shadow. Abdominal computerized tomography showed a subcapsular shadow in the left kidney. Because her symptoms was aggravated, left nephrectomy was performed under the diagnosis of emphysematous pyelonephritis. There was no mainfestation of her prior symptoms after the operation, and she was discharged on the 19th postoperative day. In Japan, 43 cases of emphysematous pyelonephritis have been reported in the literature. These 43 cases were studied clinically and in comparison to the cases reported in Western countries. The male-to-female ratio was approximately 4 to 1, in contrast to the Western ratio of female preponderance.
The age of the patients showed its peak at the 50-60's, the mean age being not significantly different from that of Western patinets. 37% of the patients had the affected side on the right, 56% on the left, and 7% bilaterally. This was comparable to the results of Western countries. 93% of the subjects suffered from diabetes mellitus as the basal malady, which was comparable to that in Western studies. However, patients afficted with urinary pasage impairment accounted for 14%. This incidence was lower than that reported in Western studies. The phlogogenic bacteria of this disorder were E. coli (58%) and Klebsiella (23%), being similar to what was found in Western studies. As treatment, chemotherapy was administered in 30% of the cases and surgery was performed in 60%. The surgery performed was nephrectomy (49%), drainage through incision (12%) and for ureterocutaneous or nephric fistula (5%). Fatality rates were 23% after chemotherapy, 11% after surgery, and 100% in non-treated subjects. Although the difference was not as marked as that observed in Western studies, surgical treatment gave better results.
