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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal emphysema is a rare, fulminant, suppurative infection of pelvicaliceal system, renal parenchyma, perinephric tissues, and retroperitoneum. It is characterized by formation of gas. Invariably this condition is associated with diabetes mellitus and carries high mortality (40-90%). Renal emphysema can be classified into two distinct clinical entities: emphysematous pyelitis and emphysematous pyelonephritis. This classification has important prognostic and therapeutic implications. Herein we describe the computed tomographic findings in five unilateral cases of renal emphysema (two cases of emphysematous pyelitis and three cases of emphysematous pyelonephritis) in five insulin-dependent diabetic patients.
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PMID:Renal emphysema in diabetic patients: CT evaluation. 1983 84

A total of 82 episodes of diabetic ketoacidosis were analysed in 70 adult patients. Population characteristics can be seen in Table 1. It was possible to determine the causes of 74 episodes (Table 2); infections, insulin reduction or suppression and psychic stress included 89 % of these causes. The most frequent infection sites were airway, urinary tract and skin surface. The most important symptoms and signs shown by patients on admission (Table 3) were digestive and those derived from dehydration and acidosis. Figure 2 shows laboratory data on admission: average glycemia, 395 mg %, 90 % with pH values below 7.30; the majority revealed high hematocrit urea and kaliemia values. Unusual treatment performed in the classical way (Figure 3) can be divided into two periods: the first of eapid expansion and insulinization (first three hours) and the second of slow replenishment (4 to 24 hours) consisting of two stages in which the velocity of liquid infusion is diminished while glucose and potassium backing is started. No difference was found between the results of those who received bicarbonate and those who did not (Table 4). Response to treatment is shown in Fig. 4. On pointing out the decrease in kalemia (1.18 mEq/l in the first 6 hours), however, it must be kept in mind that on admission 10 % of the patients were in a state of hypokalemia with less than 3.5 mEq/l. Table 5 shows complications that arose during treatment: hypokalemia, 32 %; hupoglucemia, 11 % and phlebitis, 17 % (catheterized). Five patients, (7 5) died. Four had been admitted in a state of coma with a severe infectious state (bronchopneumonia, acute pyelonephritis, meningo-encephalitis). The analysis of this paper shows the importance of an adequate diabetic education and briefing both for the patients, to be aware of the unleashing factors, and for the physicians, in order to avoid the complications of treatment.
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PMID:[Diabetic ketoacidosis. Revision of 82 episodes]. 2216 95

Emphysematous pyelonephritis (EPN) is a rapidly progressive necrotizing infection characterized by gas in the kidneys. We describe a 48-year-old woman, a newly diagnosed diabetic, who presented with clinical features of right sided pyelonephritis with hematuria of short duration. On further evaluation, she was diagnosed to have right sided EPN, with thrombus in the renal vein and inferior vena cava (IVC). She was managed conservatively with hydration, insulin, intravenous antibiotics, anticoagulants and ureteric stenting on the right side. On follow-up, the gas shadows resolved and the thrombus completely regressed.
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PMID:Emphysematous pyelonephritis with IVC thrombus in new onset diabetes mellitus. 2423 99

A 54-year-old male with long-standing diabetes presented with vague left flank pain for 5 days with uncontrolled blood glucose. The patient was commenced on insulin and injectable ceftriaxone empirically, for possibly acute pyelonephritis. Ultrasound examination revealed extensive emphysematous pyelonephritis of upper half of left kidney with involvement of perinephric space. Computed tomography of abdomen confirmed the diagnosis of emphysematous pyelonephritis which was categorised as class IIIa. The recommended treatment for class IIIa emphysematous pyelonephritis is nephrectomy but the patient refused to give consent for surgery or even percutaneous drainage. Thus, the patient was continued on medical management alone and surprisingly showed marked recovery over the next few days. There were no new complications, and the patient was discharged after 2 weeks of antibiotics with 2 more weeks of oral antibiotics. After 4 months, the ultrasound showed normal kidneys. We present this case because it adds to the little existing evidence that conservative management can successfully cure patients with class IIIa emphysematous pyelonephritis, although supplementation with percutaneous drainage would have been better in this case.
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PMID:Emphysematous pyelonephritis (class IIIa) managed with antibiotics alone. 2623 34

Emphysematous pyelonephritis is a rare but dangerous condition in patients with D.M. and urinary tract infection. We report a case of emphysematous pyelonephritis who presented to us with acute abdomen and sepsis. Her CT abdomen showed air in the collecting system of left kidney. She was managed with, I. V. fluids, antibiotics, insulin, and percutaneous nephrostomy. But she died on the 3rd day of hospitalisation due to Multiorgan failure with sepsis.
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PMID:A Case of Emphysematous Pyelonephritis. 2628 87

A 40-year-old woman withuntreated type II diabetes mellitus was discovered withcardiopulmonary arrest in her room. On admission, she had ventricular fibrillation. After cardiopulmonary resuscitation, her own pulse restarted. The plasma glucose was 722 mg/dl and venous PH was 6.704. Abdominal computed tomography revealed gas within the parenchyma of the left kidney. We diagnosed her with emphysematous pyelonephritis and conducted emergency nephrectomy. Urinary and blood cultures were positive for Escherichia coli. Antibiotic therapy was initiated with doripenem and she was restrictively treated with intravenous insulin to control her plasma glucose. On the 8th day of hospital stay, she underwent resection of the small intestine because of necrosis. After multidisciplinary therapy, she was discharged with complete resolution of the infection.
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PMID:[Emphysematous Pyelonephritis with Cardio-Pulmonary Arrest : A Case Report]. 2762 8

Acute emphysematous pyelonephritis (EPN) is a severe kidney infection. Early and effective treatment is essential to reduce high mortality rates due to this disease. Our study aims to highlight the clinical and paraclinical features as well as the peculiarities of therapeutic management of this disease and focus on the possibility of conservative treatment in diabetic patients. We analyzed the medical records of patients with EPN treated in the Department of Urology at the Hassan II University Hospital, Fez between January 2004 and January 2010. For each medical record we described clinical, paraclinical and therapeutic features as well as patient's evolution after treatment. We here report the case of 5 female patients whose average age was 45,6 years. All patients were diabetic. Lithiasic obstruction of the upper urinary tract was found in 3 patients (60%). The diagnosis was made by means of abdominal CT scan. All patients underwent resuscitation measures including antibiotic and insulin therapy. Conservative surgical procedure was performed in all cases. Indeed, surgical drainage of perirenal collections was performed in two cases, percutaneous renal drainage in one case and drainage using double-J ureteral catheter in 2 cases. Clinical and radiological evolution was excellent with renal preservation in all patients Emphysematous pyelonephritis is a rare and serious complication, especially in diabetic patients. Diagnosis is based on CT scan. Surgical treatment should be conservative in most cases, apart from severe forms, especially in diabetic patients who have potential risk of chronic renal failure.
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PMID:[Conservative treatment in diabetic patients with emphysematous pyelonephritis: about five cases]. 2829 13

A 78-year-old black woman with a 10-year history of diabetes mellitus was admitted to the intensive care unit. Upon admission, she presented with chills, nausea, and left flank pain. The presence of hyperglycemia (fasting blood glucose, 19.7 mmol/L) and an altered consciousness required immediate treatment with insulin analog. Laboratory investigations and enhanced computed tomography scan led to the diagnosis of bilateral emphysematous pyelonephritis (EPN). The patient responded well to conservative treatment with antibiotics, and was finally discharged after 22 days when the computed tomography scan showed resolution of all the pockets of air. This case and associated literature review of 25 previously reported cases of bilateral EPN show the changing trend of EPN management from emergency nephrectomy toward conservative treatment with potent antibiotics and/or percutaneous drainage, and has been associated with higher survival rates compared to emergency nephrectomy.
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PMID:Bilateral emphysematous pyelonephritis cured by antibiotics alone in a black African woman. 3000 86

Prickly heat is a benign cutaneous manifestation due to the obstruction of the sweat ducts following excessive exposure to heat, humidity or hyperthermia. We report the case of a 70-year old diabetic female patient treated with insulin, hospitalized in the Intensive Care Unit due to acidocetosic coma secondary to pyelonephritis. The patient had diffuse clear vesicular lesions spread all over the body,(a) firm to palpation, on a healthy skin, suggesting miliaria crystallina. Miliaria crystallina is a benign cutaneous manifestation due to sweat retention secondary to obstruction of the sweat ducts. It is possible to distinguish between miliaria crystallina due to the obstruction in the stratum corneum, miliaria rubra due to the obstruction within the malpighian stratum and miliaria profunda due to an obstrusction in or below the dermoepidermal junction, depending on the level of obstruction. Miliaria crystallina heals spontaneously in a few hours giving rise to a desquamation, as occurred in our patient after regression of febrile syndrome.
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PMID:[Widespread miliaria crystallina: about a case]. 3034 53

BACKGROUND Emphysematous osteomyelitis of the spine is characterized by intravertebral or intraosseous air. Emphysematous pyelonephritis (EP) is the infection of the renal parenchyma and perirenal tissues caused by gas forming microorganisms and thus is characterized by gas formation. Prompt diagnosis and initiation of necessary treatment is crucial, as both entities are associated with high mortality rates. CASE REPORT A 57-year-old female with uncontrolled hyperglycemia presented to the emergency department with history of sudden onset of weakness, nausea, vomiting and diarrhea for 3 days and with a fall on the same level the previous day. Laboratory examinations revealed leukocytosis, lymphopenia, thrombocytopenia, deteriorated renal function, and hyperglycemic hyperosmolar non-ketotic state. She was placed on aggressive intravenous hydration and insulin infusion pump. Due to the deterioration of her medical condition, she underwent abdominal and pelvic CT scanning that revealed emphysematous osteomyelitis of the spine and emphysematous pyelonephritis. Despite vigorous fluid resuscitation and systemic broad-spectrum antibiotic therapy, the patient's condition deteriorated further and eventually led to death within 48 h. CONCLUSIONS This case of fatal emphysematous osteomyelitis of the spine and EP serves as a significant reminder of those rare life-threatening entities, which affect patients with comorbidities, such as diabetes mellitus and other etiologies causing immunosuppression. The aim of the present case report is to highlight the importance and contribution of computed tomography in diagnosing these conditions and to emphasize the rare coexistence of these 2 emphysematous entities.
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PMID:Simultaneous Diagnosis of Emphysematous Osteomyelitis and Emphysematous Pyelonephritis in a Diabetic Patient. 3178 44


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