Emphysematous pyelonephritis: a case report
10.3760/cma.j.cn112330-20240422-00195
- VernacularTitle:气肿性肾盂肾炎1例报告
- Author:
Nannan GUO
1
;
Xiaoying ZHANG
;
Anning WANG
;
Hu ZHANG
Author Information
1. 辽宁省健康产业集团阜新矿总医院肾内科，阜新 123000
- Publication Type:Journal Article
- Keywords:
Emphysematous pyelonephritis;
Mortality risk factors;
Multidisciplinary team
- From:
Chinese Journal of Urology
2025;46(4):295-296
- CountryChina
- Language:Chinese
-
Abstract:
We present a case of emphysematous pyelonephritis (EPN) in a patient who developed fever and generalized pain one week prior to admission. Initial laboratory tests at a local hospital revealed leukocytosis (WBC 17.23×10 9/L), thrombocytopenia (PLT 97×10 9/L), elevated serum creatinine (502 μmol/L), and severe hyperglycemia (31.11 mmol/L). The patient was transferred to our institution following 1 day of symptomatic treatment due to newly developed hallucinations and convulsions. One day after admission, the patient presented with impaired consciousness, cutaneous ecchymosis, and gross hematuria. CT showed extensive gas accumulation within and around the left kidney, with minimal gas noted along the medial diaphragmatic crus. Laboratory findings showed progressive leukocytosis (WBC 22.93×10 9/L), critical thrombocytopenia (PLT 11×10 9/L), and markedly elevated C-reactive protein (309.06 mg/L). After being transferred to the ICU for treatment, the vital signs were stable but the patient remained somnolent. A surgical exploration by the urology department revealed severe infection and necrosis of the left kidney, and a left nephrectomy was performed. Postoperative renal function monitoring showed persistent elevation of serum creatinine (>400 μmol/L), which gradually improved to 200.6 μmol/L following targeted therapy, along with normalized WBC (5.42×10 9/L) and platelet counts (363×10 9/L). The patient achieved full recovery with normal follow-up CT and renal function tests. This case emphasizes the severity of emphysematous pyelonephritis and underscores the multidisciplinary collaboration. Early diagnosis, timely surgical intervention, and critical care support are key to improving prognosis.
