[Emphysematous pyelonephritis. Case report].
OBJECTIVE
To describe an unusual case of emphysematous pyelonephritis, a disease with high morbidity and mortality.


METHODS
We present the case of a 62-year old diabetic female with history of kidney stones, who consulted for fever, left lower-back pain and impairment of the general condition. Abdominopelvic computed tomography revealed a perinephric collection of air reaching the abdominal wall.


RESULTS
After initial medical management with antibiotics and general supportive measures, we performed an open incision and drainage. A week later, signs of sepsis reappeared and the left kidney was excised. The patient died two weeks later of septic shock.


CONCLUSIONS
This disease must be suspected in diabetic females with renal lithiasis and pyelonephritis not responding to treatment, and impaired general condition. Early diagnosis (computed tomography is the gold-standard) and supportive measures are essential for initial management. Surgery can be open (drainage, initial or deferred nephrectomy), percutaneous (nephrostomy) or endoscopic (double-J stent). Conservative management is a choice in bilateral or mild cases. Mortality rate is high and worsens with delayed therapy.
Dellavedova
Tristán
T
FUCDIM (Fundación Urológica Córdoba para la Docencia e Investigación Médica), Cordoba, Argentina. trisdellavedova@hotmail.com
Racca
María Laura
ML
Ponzano
Rolando
R
Sarría
Juan Pablo
JP
Minuzzi
Federico
F
Minuzzi
Gustavo
G
D004646:Emphysema / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011704:Pyelonephritis / Q000150:complications / Q000175:diagnosis / Q000628:therapy