KH.S. KHAERTYNOV¹, R.KH. ZAKIROV², B.M. SHAIKHRAZIEV^3, 4, A.B. SHAIKHRAZIEVA¹, T.V. PODRYADNOVA²

 ¹Kazan State Medical University, Kazan

²Republican Clinical Infectious Diseases Hospital named after Prof. A.F. Agafonov, Kazan

³Republican Clinical Hospital, Kazan

⁴Kazan State Medical Academy — Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan

Contact details:

Khaertynov Kh.S. — MD, Associate Professor of the Department of Children’s Infections

Address: 36 Butlerov St., 420012 Kazan, Russian Federation, tel.: +7-903-342-96-27, e-mail: khalit65@yandex.ru

Emphysematous pyelonephritis (EP) is a rare form of acute purulent pyelonephritis that develops as a result of the action of a gas-forming bacterial flora. A case of EP is described in a 60-year-old female patient with type 2 diabetes mellitus (DM). The disease was accompanied by fever and lumbar pain. The number of leukocytes in blood increased up to 17 × 10⁹/l and C-reactive protein up to 197 mg/l. The blood glucose was 22.5 mmol/l. A contrast-enhanced CT scan of the abdomen revealed an enlarged left kidney, infiltration of the paranephric tissue of the left kidney and gas in the in the calyxes, pelvis, and throughout the ureter. The patient underwent radical nephrectomy on the left. Conservative treatment included antibacterial and infusion therapy, correction of glycemia with insulin. The patient was discharged on the 12^th day of illness in satisfactory condition.

Key words: emphysematous pyelonephritis, diabetes mellitus, computed tomography.

REFERENCES

1. Novinskiy A.A., Zinukhov A.F. Emphysematous pyelonephritis: epidemiology, modern approaches to diagnosis and treatment. Eksperimental’naya i klinicheskaya urologiya, 2020, vol. 13, no. 5, pp. 100–105 (in Russ.). DOI: 10.29188/2222-8543-2020-13-5-100-105
2. Michaeli J., Mogle P., Perlberg S. et al. Emphysematous pyelonephritis. J. Urol, 1984, vol. 131 (2), pp. 203–208. DOI: 10.1016/s0022-5347(17)50309-2
3. Schultz E.H., Klorfein E.H. Emphysematous pyelonephritis. J. Urol, 1962, vol. 87, pp. 762–766. DOI: 10.1016/S0022-5347(17)65043-2
4. Hinkamp C.A., Keshvani N. Emphasising classification in emphysematous pyelonephritis. Lancet, 2020, vol. 395, r. 1145. DOI: 10.1016/s0140-6736(20)30475-x
5. Bamanikar A., Dhobale S. Fever with abdominal pain and diabetes — Is it emphysematous pyelonephritis? Malays J. Med. Sci, 2014, vol. 21 (3), pp. 85–88.
6. Robles-Torres J.I., Ocaña-Munguía M.A., Arrambide-Herrera J.G. et al. What is the prognosis of emphysematous pyelonephritis associated with extended-spectrum beta-lactamases producing microorganisms? Asian J. Urol, 2022, vol. 9, pp. 146–151. DOI: 10.1016/j. ajur.2021.04.012
7. Ma L.-P., Zhou N., Fu Y. et al. Emphysematous pyelonephritis: six case reports and review of literature. World J. Clin. Cases, 2022, vol. 10, pp. 3268–3277. DOI: 10.12998/wjcc.v10.i10.3268
8. Wan Y.L., Lee T.Y., Bullard M.J. et al. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology, 1996, vol. 198, pp. 433–438. DOI: 10.1148/radiology.198.2.8596845
9. Desai R., Batura D. A systematic review and meta-analysis of risk factors and treatment choices in emphysematous pyelonephritis. Int. Urol. Nephrol, 2022, vol. 54, pp. 717–736. DOI: 10.1007/s11255-022-03131-6
10. Ubee S.S., McGlynn L., Fordham M. Emphysematous pyelonephritis. BJU Int, 2011, vol. 107 (9), pp. 1474–1478. DOI: 10.1111/j.1464-410X.2010.09660.x
11. Ngo X.T., Nguyen T.T., Dobbs R.W. et al. Prevalence and risk factors of mortality in emphysematous pyelonephritis patients: a meta-analysis. World J. Surg, 2022, vol. 46, pp. 2377–2388. DOI: 10.1007/s00268-022-06647-1
12. Yang Z., Li Z. Sepsis caused by emphysematous pyelonephritis: a case report. Front Med, 2023, vol. 9. 1038455. DOI: 10.3389/fmed.2022.1038455
13. Doronin A.B., Zipunnikov V.P., Kuznetsov A.A. et al. Bilateral emphysematous pyelonephritis and emphysematous cystitis: a clinical case. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta, 2023, vol. 20, no. 3, pp. 153–158 (in Russ.). DOI: 10.19163/1994-9480-2023-20-3-153-159
14. Falagas M.E., Alexiou V.G., Giannopoulou K.P. et al. Risk factors for mortality in patients with emphysematous pyelonephritis: A meta-analysis. J. Urol, 2007, vol. 178, pp. 880–885. DOI: 10.1016/j.juro.2007.05.017
15. Holt R.I.G., Cockram C.S., Ma R.C.W. et al. Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment. Diabetologia, 2024, vol. 67, pp. 1168–1180. DOI: 10.1007/s00125-024-06102-x
16. Nitzan O., Elias M., Chazan B. et al. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2015, vol. 8, pp. 129–136. DOI: 10.2147/DMSO.S51792
17. Huang J.J., Tseng C.C. Emphysematous pyelonephritis: clinic radiological classification, management, prognosis, and pathogenesis. Arch. Intern. Med, 2000, vol. 160 (6), pp. 797–805. DOI: 10.1001/archinte.160.6.797
18. Irfaan A.M., Shaikh N.A., Jamshaid A. et al. Emphysematous pyelonephritis: a single center review. Pak. J. Med. Sci, 2019, vol. 36, pp. 83–86. DOI: 10.12669/pjms.36.ICON-Suppl.1728
19. Wan Y.L., Lo S.K., Bullard M.J. et al. Predictors of outcome in emphysemayous pyelonephritis. J. Urol, 1998, vol. 159, pp. 369–373. DOI: 10.1016/s0022-5347(01)63919-3
20. Lu Y.C., Chiang B.J., Pong Y.H. Predictors of failure of conservative treatment among patients with emphysematous pyelonephritis. BMC Infect. Dis, 2014, vol. 14, r. 418. DOI: 10.1186/1471-2334-14-418