title: Emphysematous pyelonephritis in a diabetic patient on maintenance hemodialysis: a case report.
abstract: BACKGROUND
  Emphysematous pyelonephritis (EP) is an uncommon acute infection characterized by the presence of gas in the renal parenchyma. It is extremely rare in hemodialysis (HD) patients and diabetics account for most cases. It is a rapidly progressive and life threatening infection with a high mortality rate. We report a case of emphysematous pyelonephritis in a HD patient who was treated successfully with radical nephrectomy and antibiotic therapy.
  
  
  METHODS
  A 46-year-old diabetic male with end stage renal disease (ESRD) secondary to diabetic nephropathy and on maintenance HD for the last five years presented with a two weeks history of fever and loin pain. He was treated with oral ciprofloxacin for one week with no improvement. His blood culture isolated Escherichia coli. Computed tomography scan of the abdominal disclosed an enlarged left kidney with massive gaseous collections. Accordingly, the diagnosis of emphysematous pyelonephritis was put forward, the patient underwent left nephrectomy together with intravenous imipenum and amikacin with good clinical response. The removed kidney showed features of acute pyelonephritis with micro-abscesses on histopathology. .
  
  
  CONCLUSIONS
  Emphysematous pyelonephritis should always be considered in diabetics presenting with fever, loin pain, and features of sepsis not responding to antibiotic therapy; even though being on dialysis. Computed tomography scan of the abdomen remains an early diagnostic tool. Early treatment with potent antibiotics with or without surgical intervention can save patients' life.
authors.affiliation: Departement of Nephrology, Fattouma Bourguiba Hospital and University Faculty of Medicine, Monastir, Tunisia.
authors.forename: M
authors.initials: M
authors.lastname: Hamouda
authors.affiliation: Departement of Nephrology, Fattouma Bourguiba Hospital and University Faculty of Medicine, Monastir, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Aloui
authors.affiliation: Departement of Nephrology, Fattouma Bourguiba Hospital and University Faculty of Medicine, Monastir, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Skhiri
authors.affiliation: Departement of Nephrology, Fattouma Bourguiba Hospital and University Faculty of Medicine, Monastir, Tunisia.
authors.forename: A
authors.initials: A
authors.lastname: Letaif
authors.affiliation: Departement of Nephrology, Fattouma Bourguiba Hospital and University Faculty of Medicine, Monastir, Tunisia.
authors.forename: M A
authors.initials: MA
authors.lastname: Frih
authors.affiliation: Departement of Nephrology, Fattouma Bourguiba Hospital and University Faculty of Medicine, Monastir, Tunisia.
authors.forename: N
authors.initials: N
authors.lastname: Ben Dhia
authors.affiliation: Departement of Nephrology, Fattouma Bourguiba Hospital and University Faculty of Medicine, Monastir, Tunisia.
authors.forename: M
authors.initials: M
authors.lastname: Elmay
mesh_terms: D048909:Diabetes Complications / Q000150:complications*; D004646:Emphysema / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011704:Pyelonephritis / Q000209:etiology* / Q000628:therapy; D006435:Renal Dialysis / Q000379:methods*