Emphysematous pyelonephritis – case report and review of literature

Dejan Ćelić; Dušan Božić; Kosta Petrović; Srđan Živojinov; Tatjana Đurđević Mirković; Milica Popović

doi:10.2298/VSP160328312C

Dejan Ćelić Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Dušan Božić Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Kosta Petrović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia Clinical Center of Vojvodina, Center for Radiology, Novi Sad, Serbia
Srđan Živojinov University of Novi Sad, †Faculty of Medicine, Novi Sad, Serbia Clinical Center of Vojvodina, Clinic for Urology, Novi Sad, Serbia
Tatjana Đurđević Mirković Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Milica Popović Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP160328312C

Ključne reči: pyelonephritis||, ||pijelonefritis, emphysema||, ||emfizem, diabetes mellitus, type 1||, ||dijabetes melitus, insulin zavisni, drainage||, ||drenaža, treatment outcome||, ||lečenje, ishod,

Sažetak

Uvod. Emfizematozni pijelonefritis je teška, potencijalno fatalna, nekrotizirajuća infekcija bubrega sa kliničkom slikom koja može varirati od blagih abdominalnih bolova do septičkog šoka sa multiorganskom insuficijencijom. Prikazan je slučaj emfizematoznog pijelonefritisa kod višegodišnjeg dijabetičara, što je prvi registrovan slučaj ovog oboljenja na našoj klinici u periodu dužem od deset godina. Prikaz bolesnika. Muškarac star 78 godina, sa višegodiš-njim, loše regulisanim dijabetesom, hospitalizovan je na Klinici za nefrologiju i kliničku imunologiju Kliničkog centra Vojvodine u Novom Sadu, sa tegobama u vidu slabosti, malaksalosti, bolova u stomaku i smanjene količine mokraće. Nakon fizikalnog pregleda, laboratorijskih analiza, ehosonografskog pregleda i kompjuterizovane tomografije abdomena postavljena je dijagnoza emfizematoznog pijelonefritisa klase IV po klasifikaciji Huanga i Tsenga. Kod prikazanog bolesnika verifikovano je postojanje pet faktora loše prognoze (sistolni krvni pritisak ispod 90 mmHg, poremećaj svesti, trombocitopenija, povišen nivo serumskog kreatinina, bilateralna bolest). Primenjena konzervativna terapija i perkutana drenaža nisu rezultirale povoljnim ishodom i došlo je do daljeg pogoršanja stanja bolesnika. Bolesnik je preminuo osmog dana hospitalizacije usled razvoja septičkog šoka i multiorganske insuficijencije koja je bila refrakterna na sve primenjene mere. Zaključak. Emfizematozni pijelonefritis predstavlja tešku, potencijalno fatalnu nekrotizujuću inflamaciju bubrega i okolnog tkiva. Terapija i prognoza ove bolesti zavise od kliničkog statusa, prisutnih faktora rizika i radiološke klasifikacije bolesti.

Biografija autora

Dejan Ćelić, Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

Docent na Katedri za internu medicinu

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