RESUMO
La pielonefritis enfisematosa, más que una entidad poco frecuente, se considera subdiagnosticada, pues requiere gran agudeza clínica para su identificación. Se define como una complicación necrotizante del riñón, que pone en peligro la vida del paciente y que se caracteriza por la acumulación de gas en el parénquima renal y los tejidos vecinos. Este caso se presentó de forma epidemiológicamente atípica por tratarse de un hombre con una anomalía renal y del tracto urinario, el riñón en herradura, lo que vuelve aún más complejo el abordaje diagnóstico y manejo de esta patología. Este caso es una referencia de la experiencia en el abordaje con catéter percutáneo como opción no tradicional de tratamiento. Se realizó una revisión de la literatura para tratar de comprender mejor las opciones en estudios de imagen para su diagnostico y las características clínicas
Emphysematous pyelonephritis, more than a rare entity, is considered underdiagnosed, as it requires great clinical acuity for its identification. It is defined as a necrotizing complication of the kidney, which endangers the patient's life and is characterized by the accumulation of gas in the renal parenchyma and neighboring tissues. This case presented in an epidemiologically atypical manner because it was a man with a kidney and urinary tract anomaly, the horseshoe kidney, which makes the diagnostic approach and management of this pathology even more complex. This case is a reference of the experience in the percutaneous catheter approach as a non-traditional treatment option. A review of the literature was carried out to try to better understand the options in imaging studies for its diagnosis and the clinical characteristics
Assuntos
Humanos , Idoso , El SalvadorRESUMO
Objective To discusse the diagnosis and treatment of kidney stones with emphysema pyelonephritis.Methods The clinical data of 8 patients with kidney stones complicated with emphysema pyelonephritis diagnosed in our hospital from January 2015 to October 2018 were retrospectively analyzed.There were 5 males and 3 females.The average age was 50 years old.The clinical manifestations including chills fever in 6 cases,low back pain in 5 cases,nausea and vomiting in 3 cases.Six patients had diabetes,one had thalassemia,and two had contralateral kidney stones.The maximum cross-sectional area of stones was 737.6 mm2.Among the 8 cases,there were 7 cases which number of white blood cells and procalcitonin were higher than normal reference value.4 cases of hemoglobin ＜ 110 g/L,2 cases of platelet count ＜ 125 × 109/L.The patient was cultured with urine and/or blood and drainage fluid.5 cases were Escherichia coli,2 cases were infected with Proteus mirabilis,and 1 case was infected with Pseudomonas aeruginosa.According to the CT findings of emphysematous pyelonephritis reported in the literature,it was divided into type Ⅰ-Ⅳ:There were 2 cases of type Ⅰ,2 cases of type Ⅱ,3 cases of type Ⅲ,and 1 case of type Ⅳ.Results 4 cases of type [and type Ⅱ patients,2 cases without SIRS were given positive medical treatment to control infection then performed PCNL.2 cases with SIRS,first treated with percutaneous nephrolithotomy and active medical,after control infection the PCNL was performed.None of the 4 patients were treated with ICU and recovered well after surgery.Three patients with type Ⅲ and one patient with type Ⅳ were complicated with SIRS.Two of them underwent percutaneous nephrolithotomy in the emergency department.They were transferred to the ICU after surgery.After the infection and general condition improved,PCNL was performed.The postoperative recovery was satisfied.One patient percutaneous nephrolithotomy,due to poor drainage,secondary percutaneous nephrolithotomy,large intrachannel,low pressure perfusion in the operation of partial obstruction of renal pelvis stones,dredge obstruction,after ICU control infection PCNL was performed,postoperative recovery was good.One patient with type Ⅲ also had poor peritoneal drainage for the first time.Secondary percutaneous nephrolithotomy was performed.After the infection was controlled by ICU,PCNL was performed to remove the stones.However,because the patient had contralateral kidney stones and thalassemia,an epileptic-like reaction occurred during the anti-infection with imipenem,and a serious infection occurred again after the operation,and eventually the patient died.Conclusions Patients with type Ⅰ and Ⅱ emphysematous pyelonephritis with renal calculi treated with conservative medical treatment alone or combined with percutaneous renal puncture drainage with SIRS can achieve better therapeutic effects after PCNL surgery.Type Ⅲ,Ⅳ emphysema pyelonephritis with renal calculus patients need to be actively anti-infective accompany with percutaneous renal puncture drainage.When the stone leads to multiple renal pelvic obstruction,large channels,low-pressure perfusion can be used to crush stones,dredge obstruction.PCNL was performed after infection control.