Nazareth S and Krishnamoorthy S*
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, IndiaFulltext PDF
Emphysematous pyelonephritis is an acute infection of the kidney causing parenchymal destruction, caused by gas-forming organisms. If left undiagnosed or untreated, it will cause severe damage to renal function. While the prognosis in most patients is very poor, the outcome gets further worsened in the presence of urinary tract obstruction or active infection. Uncontrolled blood sugars and fungal septicemia further alters the prognosis. We report a case report of a middle aged male who presented to the emergency room with very high blood sugar level, altered sensorium and high fever, chills and rigor. On evaluation with Computed Tomography (CT) of abdomen, there was a 1.9 cm calculus at the uretero-pelvic junction, densely impacted and obstructing the drainage from right kidney and class 3b Emphysematous pyelonephritis extending to perinephric space and psoas sheath. Various prognostic factors and risk stratification strategies are documented by multiple authors that decide the final outcome in these patients. Our patient fell in the intermediate risk category, which necessitated a prompt glycemic control, correction of acid base imbalance, immediate disimpaction of stone and decompression of the pelvicalyceal system with percutaneous drainage of the perinephric and psoas collection. This case report illustrates the lethal combination of obstruction and uncontrolled blood sugar levels in patients with gas forming infection of the kidney. Physicians should be alert and be well aware of this fatal combo and ensure that a prompt diagnosis is made and triaged accordingly in order to salvage the kidney and safe the life of the individual.
Emphysematous pyelonephritis; Renal calculus; Hydronephrosis; Psoas abscess
Nazareth S, Krishnamoorthy S. Renal Calculus Obstruction with Emphysematous Pyelonephritis in a Diabetic Male: A Lethal Combo. Ann Clin Case Rep. 2021; 6: 1946..