Vanishing kidney disease

Abstract

DESCRIPTIONA 60-year-old woman with a known case of diabetes mellitus for last 25 years, presented to our emergency department with symptoms of severe colicky pain in the right lumbar region and paraumbilical region of abdomen and recurrent episodes of vomiting the day before admission. Her family doctor recently moved her on to insulin as her blood sugar was not being controlled by oral antidiabetics. Systemic examination was normal except for severe tenderness in right lumbar and paraumblical regions. Random blood sugar was 364 mg/dL, arterial blood gas analysis revealed metabolic acidosis and urine was positive (+++) for ketones. A diagnosis of diabetic ketoacidosis was made and an intravenous normal saline and intravenous insulin infusion was started. Within 6 h of admission, her blood sugar level came within the normal range, metabolic acidosis subsided and urine ketones became negative; however, pain in abdomen and vomiting still persisted. Routine urine examination revealed pus cells of 15-20/high power field, and few epithelial cells. Complete blood count revealed haemoglobin 13.4 g%, total leucocyte count 16 700 cells/mm 3 , differential count showed shift to left, with neutrophils 91%, platelets were adequate. A urine culture after 24 h revealed growth of Escherichia coli, which was sensitive to piperacillin and tazobactum and amikacin, so we immediately changed the antibiotics accordingly. A plain X-ray of the abdomen revealed an oval-shaped gas shadow in the right side of the abdomen ( figure 1). An ultrasonography of abdomen was unable to delineate the right kidney properly and an urgent contrast-enchanced CT was performed which revealed features suggestive of right emphysematous pyelonephritis ( figure 2A,B). We consulted with our urology department and a percutaneous nephrostomy was performed but the patient's condition gradually deteriorated and she expired on the seventh day after admission. Emphysematous pyelonephritis is a rare necrotising pyelonephritis with a variable clinical picture ranging from mild abdominal pain to septic shock. It is a life-threatening condition that usually affects

Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review

“…Harrabi et al reported a 64-yearold woman with EPN complicated with diabetic ketoacidosis who died of septic shock without surgical drainage [6]. However, another patient with EPN with diabetic ketoacidosis who underwent percutaneous renal drainage combined with antibiotics died 7 days after admission [9]; Unlike our patient, according to CT, this patient belongs to class 3A EPN. Recently, it has been reported that EPN with diabetic ketoacidosis in the patient with allogeneic renal transplantation improved after conservative treatment with intravenous antibiotics without percutaneous drainage or nephrectomy [10]; But our patient is different from this successful case in that there are urinary tract obstruction factors such as right kidney stone and right ureteral stone, and percutaneous drainage is more important in the treatment.…”

“…At present, EPN with diabetic ketoacidosis is rare, only a few cases have been reported [6][7][8][9][10]. And diabetic ketoacidosis is an important predictor of death in patients with EPN [11].…”

Vanishing Kidney: On the Far End of the Spectrum of Xanthogranulomatous Pyelonephritis

“…Interestingly, the term "the sign of the deaf kidney" or "vanishing kidney disease" has already been used in the radiology jargon for an ultrasonographic finding of emphysematous pyelonephritis, which happens due to the infiltration of the perirenal environment by gas envelope rather than the complete disappearance of the kidney parenchyma. 15…”