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

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.

Anahtar Kelimeler:

Amfizematöz piyelonefrit, amfizematöz sistit, diabetes mellitus

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

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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