LA PYELONEPHRITE AIGUE EMPHYSEMATEUSE EN REANIMATION : A PROPOS DUN CAS

Emphysematous pyelonephritis is defined by the presence of gas of bacterial origin within the renal parenchyma and in the perirenal spaces. Although rare, it is a serious condition, because untreated, its evolution remains unfortunate and its mortality varies from 50 to 90% of cases. The germ most often responsible is Escherichia coli in 60% of cases. We report an observation of a 78-year-old patient known to be non-balanced type 2 diabetic, admitted to the emergency room for a diabetic ketoacidosis on acute pyelonephritis associated to an acute respiratory distress and who presents a right lower back pain with fever, pyuria and dyspnea, all evolving in a context of alteration of the general state. CT scan confirmed the diagnosis of emphysematous pyelonephritis. The patient was hospitalized in an intensive care unit, and received rehydration, insulin therapy with correction of ketosis and hydro-electrolyte disorders, triple antibiotic therapy adapted to renal function and urinary diversion via right nephrostomy. The clinical and biological evolution was favorable; the patient spent 10 days in intensive care then was transferred to the urology department for further treatment.Based on this case and a review of the literature, the authors describe the different features of this disease. Only an urgent nephrectomy after a reanimation hospitalization can improve the prognostic.