尿管ステント留置が著効した気腫性腎孟腎炎の1例

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We present a case of emphysematous pyelonephritis successfully treated by stent placement. A 57-year-old woman with a history of renal calyx stone complained of left flank pain. Her condition deteriorated rapidly, presenting with shock, consciousness disturbance, and respiratory failure by the time of arrival to the ICU on the next day. On examination, severe inflammation (white blood cell count 15,200/μl, C-active protein 38.91 mg/dl) and renal dysfunction (blood urea nitrogen 44.9 mg/dl, creatinine 2.75 mg/dl) were obvious. Enhanced computerized tomography of the abdomen showed gas in the renal pelvis and inside the ureter. She was diagnosed with emphysematous pyelonephritis complicated by septic shock and disseminated intravascular coagulation. Intensive treatments with antibiotics, γ-globulin, catecholamines, gabexate methylate, endotoxin binding therapy and hemodialysis, were performed. Ureteric catheterization with a double J stent was performed on the second day. Endoscopic findings showed trabeculation of the bladder indicative of lower urinary obstruction. Upon catherization, drainage of purulent discharge was observed and symptoms were consequently alleviated. The patient was discharged on the 15th day. Emphysematous pyelonephritis is a fatal disease of the urinary system. Conservative therapy, percutaneous drainage and nephrectomy are recommended. It is seemed ureteric catheterization is effective.
東京女子医科大学の論文