Erschienen in:
16.05.2023 | Lessons for the Clinical Nephrologist
Emphysematous pyelonephritis in a diabetic patient
Erschienen in: Journal of Nephrology | Ausgabe 9/2023
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A 56-year-old male was referred to our department for acute kidney failure associated with increased inflammatory indexes that had evolved over 2 months. He had a history of arterial hypertension and type 2 diabetes mellitus for 20 years. Two months earlier, the patient had been treated in the Internal Medicine Department for acute pyelonephritis, characterized by fever, acute urinary retention, and significant leukocyturia (> 103/mm3). However, no specific microorganisms were identified as two different urine cultures showed polymorphic flora. At that time, blood tests revealed the following: creatinine 250 μmol/L, C-reactive protein 120 mg/L, and glycosylated hemoglobin 16.5% (Table 1). No previous blood or urine samples were available. Non-contrast abdominal computed tomography (CT) scan showed bilateral perirenal fat infiltration suggestive of edema.
Table 1
Evolution of clinical and laboratory parameters
|
Two months before admission
|
At admission
|
Six months after admission
|
Nine months after admission
|
Twelve months after admission
|
|
|---|---|---|---|---|---|
|
Weight, (kg)
|
89
|
69
|
70
|
75
|
83
|
|
Blood count
|
|||||
|
Hemoglobin level (g/dL)
|
12
|
9.4
|
9.4
|
14
|
14
|
|
Total leukocyte count (× 109/L)
|
15
|
17
|
11
|
8
|
9
|
|
Neutrophils (%)
|
76
|
78
|
75
|
77
|
75
|
|
Platelet count (G/L)
|
450
|
600
|
475
|
394
|
256
|
|
HBA1C (%)
|
16.5
|
11.5
|
7.6
|
8.1
|
8.6
|
|
Urine routine and microscopy
|
|||||
|
White blood cells (/mm3)
|
> 103
|
15,745
|
73
|
39
|
2
|
|
Red blood cells (/mm3)
|
> 103
|
186
|
135
|
87
|
17
|
|
Microscopic analysis
|
Polymorphic flora
|
Numerous yeasts
|
Numerous yeasts
|
Numerous yeasts
|
Numerous yeasts
|
|
Mycological culture
|
Not performed
|
C. albicans 106 UFC/mL
|
Negative
|
Negative
|
Negative
|
|
Beta D Glucan levels, (pg/mL)
|
Not performed
|
> 500
|
298
|
180
|
< 80
|
|
C Reactive Protein, (mg/dL)
|
180
|
192
|
59
|
5
|
4.9
|
|
Serum albumin, (g/L)
|
38
|
19
|
33
|
39
|
45
|
|
Blood creatinine, (μmol/L
|
250
|
207
|
217
|
245
|
243
|
|
eGFR, (mL/min/1.73 m2)
|
22
|
30
|
28
|
24
|
24
|