Abstract
A 42-year-old woman with diabetic ketoacidosis and fever was admitted to another hospital. She was treated by intravenous infusion of fluid, insulin and antibiotics. She was subsequently transferred to our hospital for further examination of a tender mass in the right upper quadrant in May, 1979.
Physical examinations revealed a wasted female with a temperature of 38.5°C, pulse of 78, and blood pressure of 112/70 mmHg. Initial laboratory studies gave a white blood cell count of 8, 900, fasting blood glucose of 304 mg/100 ml, blood urea nitrogen of 31 mg/100 ml, and creatinine of 2 mg/100 ml. Urinalysis showed glucose (+), acetone (-), protein (+), with numerous white blood cells per high power field. Urine culture yielded Micrococcus. A plain X-ray of the abdomen demonstrated unusual gas overlying the right renal bed. A drip infusion pyelogram revealed a normalappearing left kidney but non-functioning of the right kidney. A retrograde pyelogram indicated no ureteral obstruction. A diagnosis of gas-forming infection of the right kidney (so-called emphysematous pyelonephritis) was made. The patient did not improve despite intensive medical therapy and the right kidney was speculated to have suffered severe necrosis. Nephrectomy was therefore performed. Gas chromatographic analysis of the gas obtained from the kidney during the operation, demonstrated a significant content of carbon dioxide. Culture of pus obtained from the kidney yielded a heavy growth of E. coil. Pathologic examinations showed that the kidney parenchyma was almost totally destroyed by a yellow purulent abscess. Post-operatively, the patient recovered rapidly and her diabetes was controlled with 12 units of lente insulin daily.
A review of the 62 previously reported cases plus our own case of emphysematous pyelonephritis suggests that the majority of the patients are diabetic and emphasizes that from the viewpoint of treatment, surgical intervention tends to reduce the mortality of this lethal disea
