Diagnosis And Treatment Of Emphysematous Pyelonephritis In Patients With Diabetes

In this study we report on our experience in treating two patients diagnosed with a rare disease of emphysematous pyelonephritis, who were admitted to the Urology department of Fergana Medical Institute during 2018. We provide details on each test conducted on patients, pre- and post-surgery. Our analysis shows that to prevent complications in patients with diabetes mellitus, dispensary observation with control of glucose levels, urine and blood tests is necessary. The


INTRODUCTION
Emphysematous pyelonephritis is a severe, lifethreatening disease characterized by the presence of renal parenchymal and perirenal infections caused by gaseous microorganisms (such as E. coli). Mostly emphysematous pyelonephritis occurs in adult patients with diabetes mellitus. Today, the literature describes about 80 cases of this disease. The authors, who pay special attention to this pathology, point to its severity and note that Escherichia coli, pseudomonas and proteus can lead to the development of emphysematous inflammation in the kidneys. Bacteria enter the kidney tissue when the urinary tract is clogged with a stone, kidney abscess or hematogenous in the presence of diabetes mellitus. Localization distinguishes between unilateral and bilateral emphysematous pyelonephritis. Women get sick more often than men. The lethality of this pathology is 60-80% [2,3,5,6,].

RESEARCH METHOD
In 2018, two patients with the pathology of emphysematous pyelonephritis were admitted in the emergency urology department of Fergana Medical Institute. The first patient was admitted to the emergency urology department on February 3rd, 2018 with complaints of fever, chills, weakness, malaise, dry mouth, nausea, vomiting, pain in the left abdomen. The following are the results from the initial examination and sampling: General blood test: HB-109.0 g / l, erythrocytes 3.4x1012 / l, c.p-0.9, platelets 240.0x1012 / l, leu-10.3x109 / l, ESR-38mm / h. General urine analysis: protein-0.120 g / l, epithelium 2-3 in the field of view, leukocytes completely, erythrocytes unchanged 14-15, bacteria ++++, mucus +. In the preoperative period, in order to prepare the patient for surgery, antibacterial therapy was prescribed (IV generation cephalosporins, III generation fluoroquinolones), infusion therapy was carried out to improve blood rheology (rheosorbilact, Ringer's solution, sodium chloride solution 0.9%, sodium bicarbonate solution 4%); symptomatic therapy with anesthetic and hypothermic purpose In the postsurgical period, the patient continued adequate antibacterial and infusion therapy, transfused single-sized erythrocyte mass 0 (I) RH + in the amount of 1 liter 926 ml and fresh frozen plasma in the amount of 4 liters 402 ml. In addition, In the postsurgical period, there was a decrease in total protein to 52.0 g / l. Blood tests were repeated over time: HB-107.0 g / l, erythrocytes 3.4x1012 / l, c.p 0.9, leukocytes -10.0x109 / l, ESR 8mm / hour. General urine analysis: protein-0.055g / l, single epithelium, leukocytes 3-4 in the field of view, erythrocytes unchanged 6-8 Biochemical blood test: total protein 62.0 g / l, ALT 10.0U / L, AST-14.0 U / L, total bilirubin 12 mmol / l, bound bilirubin 2 mmol / l, free bilirubin 10 mmol / l, urea-18.4 mmol / L, glucose 10.8 mmol / L.
During 32 days of hospitalization, the general condition of the patient improved, insurance drains were removed and in a satisfactory condition was discharged for further observation by a urologist at the place of residence.
A similar case was observed in the second patient, who was transferred from the intensive care unit of the local branch of the emergency center to the intensive care unit of the Fergana Medical Institute in serious condition with complaints of fever up to 39 Celsius, dry mouth, nausea, weakness, malaise, bursting pains in the left abdomen and the lumbar region on the left. From the anamnesis, an increase in body temperature up to 39-40 Celsius is observed within a month.

Instrumental analysis -Patient 2
Ultrasound: in the perirenal space on the left, a large amount of purulent contents with the presence of gas. The left kidney is 100x45mm, TPP is 13-14mm, the kidney is displaced up to the diaphragm. The presence of fluid in the left pleural sinus is 1.2 liters. Diagnosed with Complicated form of urinary tract infection. Acute emphysematous pyelonephritis on the left. Total purulent paranephritis on the left. Urosepsis.
In the preoperative period, the patient was transfused with one-group O (I) RH + fresh frozen plasma in an amount of 480 ml, and adequate intensive antibiotic therapy was administered.