Skip to main content

Advertisement

Springer Nature Link
Log in

A case of emphysematous pyelonephritis in an older man with poorly controlled type 2 diabetes mellitus

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection characterized by gas retention and a poor prognosis. We present the case of a 75-year-old man who was diagnosed early with EPN and received multidisciplinary treatment. He had poorly controlled type 2 diabetes mellitus (DM) and chronic kidney disease (CKD), and was treated with oral hypoglycemic drugs, including a sodium–glucose co-transporter-2 inhibitor. He experienced the onset of back pain in the midsection of his back, tenderness in the costovertebral angle, and a high fever (> 39 °C), accompanied by tachycardia, hypotension, and tachypnea. The patient was diagnosed with pyelonephritis and septic shock. Immediate measures encompassing empirical antibiotic therapy, administration of noradrenaline, blood glucose regulation, and urethral catheterization were implemented. However, due to the persistent fever (> 38 °C) and lack of improvement in his condition, abdominal computed tomography (CT) was repeated on the fourth day. This revealed the presence of gas around the right kidney parenchyma, leading to a diagnosis of EPN that had evolved from acute pyelonephritis. Subsequently, percutaneous drainage of the right kidney parenchyma was performed. Subsequently, multidisciplinary treatment was continued, and his condition gradually improved. Clinicians should evaluate abdominal CT when acute pyelonephritis does not improve within a few days of antibiotic therapy. Disease progression from acute pyelonephritis to EPN should be considered in patients with DM and CKD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  1. Schainuck LI, Fouty R, Cutler RE. Emphysematous pyelonephritis. A new case and review of previous observations. Am J Med. 1968;44:134–9.

    Article  CAS  PubMed  Google Scholar 

  2. Olvera-Posada D, Armengod-Fischer G, Vázquez-Lavista LG, Maldonado-Ávila M, Rosas-Nava E, Manzanilla-García H, et al. Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico. Urology. 2014;83:1280–4.

    Article  PubMed  Google Scholar 

  3. Rahoui M, Ouanes Y, Chaker K, Bibi M, Dali KM, Sellami A, et al. Predictive factors for failure of conservative management in patients with emphysematous pyelonephritis. Ann Med Surg (Lond). 2022;78: 103930.

    PubMed  Google Scholar 

  4. Japanese Association for Infectious Disease/Japanese Society of Chemotherapy; JAID/JSC Guide/Guidelines to Clinical Management of Infectious Disease Preparing Committee; Urinary tract infection/male genital infection working group, Shingo Y, Kiyohito I, Hiroshi H, Tadahiro N, Isao M, Tadashi H, et al. JAID/JSC Guidelines for clinical management of infectious disease 2015 - urinary tract infection/male genital infection. J Infect Chemother. 2017;23(11):733–51.

    Article  Google Scholar 

  5. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000;160:797–805.

    Article  CAS  PubMed  Google Scholar 

  6. Ahlering TE, Boyd SD, Hamilton CL, Bragin SD, Chandrasoma PT, Lieskovsky G, et al. Emphysematous pyelonephritis: a 5-year experience with 13 patients. J Urol. 1985;134:1086–8.

    Article  CAS  PubMed  Google Scholar 

  7. Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology. 1996;198:433–8.

    Article  CAS  PubMed  Google Scholar 

  8. Soulen MC, Fishman EK, Goldman SM, Gatewood OM. Bacterial renal infection: role of CT. Radiology. 1989;171:703–7.

    Article  CAS  PubMed  Google Scholar 

  9. Expert Panel on Urologic Imaging, Nikolaidis P, Dogra VS, Goldfarb S, Gore JL, Harvin HJ, Heilbrun ME, et al. ACR appropriateness Criteria® acute pyelonephritis. J Am Coll Radiol. 2018;15:S232–9.

    Article  Google Scholar 

  10. Bonkat G, Bartoletti R, Bruyère F, Cai T, Geerlings SE, Köves B, et al. European Association of Urology 2022 guidelines on urological infections. https://uroweb.org/guidelines/urological-infections/summary-of-changes/2022. Accessed 5 Mar 2023.

  11. Owa S, Sasaki K, Yonemura S, Sakurai M. A case of emphysematous pyelonephritis after starting treatment for acute pyelonephritis. Hinyokika Kiyo. 2021;67:373–9.

    PubMed  Google Scholar 

  12. Takei T, Hama Y, Ito T, Takemoto M. Emphysematous pyelonephritis detected incidentally by a second CT examination after the improvement of septic shock. Nihon Shuchu Chiryo Igakukai Zasshi. 2009;16:487–91.

    Article  Google Scholar 

  13. Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N’Dow J. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008;179:1844–9.

    Article  PubMed  Google Scholar 

  14. Aboumarzouk OM, Hughes O, Narahari K, Coulthard R, Kynaston H, Chlosta P, et al. Emphysematous pyelonephritis: time for a management plan with an evidence-based approach. Arab J Urol. 2014;12:106–15.

    Article  PubMed  Google Scholar 

  15. Adapala RR, Shetty R, Venugopal P, Prabhu GGL, Yalla D, Unnikrishnan B. Renal salvage, an achievable goal in patients with emphysematous pyelonephritis: outcomes of an algorithmic renal preserving strategy. Urol Ann. 2020;12:156–62.

    Article  PubMed  PubMed Central  Google Scholar 

  16. US Food and Drug Administration. FDA drug safety communication: FDA revises labels of SGLT2 inhibitors for diabetes to include warnings about too much acid in the blood and serious urinary tract infections; updated 2018. https://www.fda.gov/drugs/drug-safety-and-availability/fda-revises-labels-sglt2-inhibitors-diabetes-include-warnings-about-too-much-acid-blood-and-serious. Accessed 21 Oct 2022.

  17. Fisher A, Fralick M, Filion KB, Dell’Aniello S, Douros A, Tremblay E, et al. Sodium-glucose co-transporter-2 inhibitors and the risk of urosepsis: a multi-site, prevalent new-user cohort study. Diabetes Obes Metab. 2020;22:1648–58.

    Article  CAS  PubMed  Google Scholar 

  18. Tanvi P, Morgan C, Jesse H, Alamdeep K, Aliza L. Evaluating the safety of sodium-glucose cotransporter-2 inhibitors in a nationwide veterans health administration observational cohort study. Am J Cardiol. 2023;201:281–3.

    Article  Google Scholar 

  19. Dave CV, Schneeweiss S, Kim D, Fralick M, Tong A, Patorno E. Sodium-glucose cotransporter-2 inhibitors and the risk for severe urinary tract infections: a population-based cohort study. Ann Intern Med. 2019;171:248–56.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mauro R, Gian PF, Angelo A. Safety of sodium-glucose cotransporter 2 inhibitors in elderly patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2023. https://doi.org/10.1111/dom.15193.Accessed26Jul.

    Article  Google Scholar 

  21. Sarah E, Christine L, Lindsay T. Evaluation of the safety and tolerability of sodium-glucose co-transporter 2 inhibitors in the older population: a systematic review. Sr Care Pharm. 2023;38:276–87.

    Article  Google Scholar 

  22. Kufel WD, Scrimenti A, Steele JM. A case of septic shock due to Serratia marcescens pyelonephritis and bacteremia in a patient receiving empagliflozin. J Pharm Pract. 2017;30:672–5.

    Article  PubMed  Google Scholar 

  23. Woloshuk A, Lee M, Assmus M, Agarwal D, Krambeck A, Large T. A case of ureteral fungal mass removal in a patient taking empagliflozin. CEN Case Rep. 2021;10:603–7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26:1553–79.

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Division of Nephrology, Nagano Municipal Hospital, 1333-1, Tomitake, Nagano, 381-8551, Japan

    Mayuka Nishikawara, Daiki Yamazaki & Tetsuji Kakegawa

  2. Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan

    Mayuka Nishikawara, Makoto Harada, Koji Hashimoto & Yuji Kamijo

Authors
  1. Mayuka Nishikawara
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Makoto Harada
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Daiki Yamazaki
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Tetsuji Kakegawa
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Koji Hashimoto
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Yuji Kamijo
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

All the authors met the ICMJE authorship criteria. All the authors contributed significantly to this work. MN, DY, and TK were treating physicians in the current case and prepared the images and data tables for the manuscript. MN, MH, and DY drafted the manuscript. TK, KH, and YK revised and supervised the manuscript. All authors approved the submission of this manuscript.

Corresponding author

Correspondence to Yuji Kamijo.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Declaration of Helsinki 1964 and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nishikawara, M., Harada, M., Yamazaki, D. et al. A case of emphysematous pyelonephritis in an older man with poorly controlled type 2 diabetes mellitus. CEN Case Rep 13, 161–167 (2024). https://doi.org/10.1007/s13730-023-00821-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-023-00821-7

Keywords

Profiles

  1. Makoto Harada View author profile