逆行性ドレナージにより軽快した気腫性腎盂腎炎の1例

Abstract

59歳女.糖尿病の既往があった.今回, 発熱, 尿路感染, 敗血症, 血小板減少, 高血糖を認め, 重症尿路感染症が疑われ紹介された.上部尿路通過障害の診断および腎盂ドレナージを目的に, 緊急に逆行性腎盂造影(RP)を施行した.腎盂尿は白濁・膿性で粘稠性が高く, これによる尿路閉塞が考えられた.RP施行時の尿培養でEscherichia coliが認められた.インスリンによる血糖コントロール, DICに対しメシル酸ガベキサート, 尿路感染症・敗血症に対しビアペネム, 乾燥ペプシン処理人免疫グロブリンによる治療を開始した.入院後5日目に解熱, 8日目に炎症反応の正常化を認め, 尿管カテーテルをDouble-pigtail(D-P)尿管ステントに交換し, 1ヵ月後にステントを抜去した.経過は良好である

A 59-year-old female was referred to our institute for urinary tract infection with septicemia, thrombocytopenia, and hyperglycemia. Plain abdominal X-ray and computed tomography (CT) showed emphysema at the left renal parenchyma and urinary tract along with the perirenal inflammatory changes. These findings suggested emphysematous pyelonephritis in the early phase of occurrence in a diabetic patient. Transurethral catheterization of the left ureter was immediately performed, and occluded cloudy urine was drained. Ureteral stent was left indwelt transurethrally for easy accession in case of occlusion. E. coli was cultured in drained urine. Administration of antibiotics, insulin, and anti-coagulant was performed, and drained urine became clear in several hours. General condition and laboratory findings were improved normally in a week, and CT did not reveal the emphysematous change of the left renal unit at the 11th hospital day.