糖尿病并气肿性肾盂肾炎误诊为急性肾盂肾炎临床分析

Clinical Analysis of Diabetes Mellitus and Emphysematous Pyelonephritis Misdiagnosed as Acute Pyelonephritis

目的探讨气肿性肾盂肾炎(emphysematous pyelonephritis,EPN)的临床诊断与鉴别诊断要点,以防范误诊。方法对1例糖尿病并EPN的临床资料进行回顾性分析并复习相关文献。结果本例以腰腹痛、高热为首发症状就诊,外院拟诊为急性肾盂肾炎,予抗感染治疗无效入我院。经监测血糖、尿酮体及行双肾CT检查诊断为糖尿病酮症酸中毒、EPN,予抗感染、控制血糖、纠正糖尿病酮症酸中毒及对症支持治疗,同时在超声引导下行经皮肾穿刺置管引流,1 d后症状即缓解,8 d后CT检查示肾脏积气积液消失,11 d后血尿常规及肾功能恢复正常。结论 EPN为急危重症,临床较为少见,易误诊。临床应加强对EPN CT影像特点的认识,以期早诊断并治疗。

Objective To investigate the clinical diagnostic characteristics and the differential diagnosis of emphyse-matous pyelonephritis （ EPN） , to prevent misdiagnosis. Methods The clinical data of one case of EPN were retrospectively analyzed with review of the literature. Results In this example, lumbar pain and high fever were recorded as the first signs of symptom, and the patient was diagnosed as having acute pyelonephritis. Anti-infection treatment was invalid before admission to our hospital. The monitoring of blood sugar, urine ketone bodies and bilateral renal CT examination indicated diabetic keto-acidosis and EPN. As anti-infection, measures of control of blood glucose, corrected ketoacidosis and symptomatic and sup-portive treatment were applied and at the same time ultrasound guided percutaneous renal puncture and catheter drainage were undertaken. The symptoms were alleviated one day later. 8 days later, CT examination revealed that kidney product gas effu-sion had disappeared. 11 days later, urinalysis and renal function returned to normal. Conclusion EPN is an acute and rare illness, which is often misdiagnosed. To strengthen understanding of CT imaging and improve awareness of EPN may help to make early diagnosis and treatment.