Kontrolsüz Diyabetes Mellitus Vakasında Nadir Görülen Amfizematöz Piyelonefrit ile Sistit Birlikteliği: Vaka Raporu ve Literatür derlemesi

Year 2019, Volume: 14 Issue: 2, 85 - 88, 15.07.2019

Hamit Yıldız

https://doi.org/10.17517/ksutfd.436448

Abstract

Amfizematöz
piyelonefrit (EP) ve amfizematöz sistit (EC) bayanlarda daha sık olmak üzere
nadir görülen bir idrar yolları enfeksiyonu tipidir. Hastaların yaklaşık %
90’nında diabetes mellitus (DM) mevcuttur. Kontrolsüz DM’li hastalarda
enfeksiyon sıklığını arttıran faktörler dokularda yüksek glukoz varlığı,
anjiyopati kaynaklı doku perfüzyonunda bozulma ve bozulmuş immün yanıttır.
Genellikle ani başlar ve hızlı seyirlidir. Septisemi ve akut böbrek yetmezliği
semptomlarını takiben kısa sürede ortaya çıkar. Laboratuvar testlerinin kısıtlı
fayda göstermesi nedeniyle kan ve idrar kültürlerinde mikroorganizmaların
üretilmesi kritik önem taşır. Gaz birikimini göstermek, lokalizasyonunu ve
sınırlarını belirlemek  için en sensitif
radyolojik test abdominal bilgisayarlı tomografidir (BT). Güncel hakim genel
görüş kültür sonuçları beklenmeksizin geniş etki spektrumlu antibiyoterapi
başlanmasını takiben hastanın klinik durumuna göre gerekirse perkütan kateter
drenajı yapılmasıdır. Yanıt alınamayan vakalarda nefrektomi yapılır. Bu nedenle
DM tanısı olan ve uygun antibiyoterapiye rağmen yanıtsız idrar yolları
enfeksiyonlarında önplanda EP veya EC düşünülmeli, tanı ve tedavi  için hızlı davranılmalıdır.

Keywords

Amfizematöz piyelonefrit, amfizematöz sistit, diabetes mellitus

Coexistence of Emphysematous Pyelonephritis and Cystitis Rarely Seen in an Uncontrolled Diabetes Mellitus Case:

Abstract

Emphysematous
pyelonephritis (EP) and emphysematous cystitis (EC) are rare urinary tract
infections that are more frequently seen in women. Nearly 90% of the patients
have diabetes mellitus (DM). In uncontrolled DM patients, factors that increase
the frequency of infection consist of presence of high glucose in tissues,
impaired tissue perfusion due to angiopathy and impaired immune response. They
generally start suddenly and progress rapidly. They develop within a short time
following septicemia and acute kidney failure symptoms. Due to the limited
benefit of laboratory tests, growing of microorganisms in blood and urine
cultures is of critical importance. The most sensitive radiological test for
showing gas accumulation as well as identifying its localization and boundaries
is abdominal computed tomography (CT). The current prevailing general opinion
favors starting broad spectrum antibiotherapy without waiting for culture
results and then performing percutaneous catheter drainage if necessary,
depending on the clinical condition of the patient. Nephrectomy is performed in
nonresponsive cases. Therefore, in urinary tract infections that are
nonresponsive despite antibiotherapy in patients diagnosed with DM, EP or EC
should be suspected primarily, and diagnosis and treatment should not be
delayed.

Keywords

Emphysematous pyelonephritis, emphysematous cystitis, diabetes mellitus

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