Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2021; 9(12): 2862-2867
Published online Apr 26, 2021. doi: 10.12998/wjcc.v9.i12.2862
Successful endoscopic surgery for emphysematous pyelonephritis in a non-diabetic patient with autosomal dominant polycystic kidney disease: A case report
Yi Jiang, Richard Lo, Zhen-Quan Lu, Xiao-Bao Cheng, Lin Xiong, Bing-Feng Luo
Yi Jiang, Richard Lo, Zhen-Quan Lu, Xiao-Bao Cheng, Lin Xiong, Bing-Feng Luo, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, Guangdong Province, China
Author contributions: Jiang Y contributed to the project development, data collection, surgery, data analysis, and manuscript composition; Lo R contributed to the supervision throughout the development of the work; Lu ZQ and Luo BF contributed to the data analysis; Cheng XB and Xiong L contributed to the data collection.
Informed consent statement: The informed written consent was waived by the Ethics Committee of the University of Hong Kong-Shenzhen Hospital. The Ethics Committee approval number is 2020144.
Conflict-of-interest statement: The authors declare that they have no competing interests to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Jiang, MM, Surgeon, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, No. 1 Haiyuan Road, Futian District, Shenzhen 518053, Guangdong Province, China. jiangy8@hku-szh.org
Received: November 20, 2020
Peer-review started: November 20, 2020
First decision: December 24, 2020
Revised: January 5, 2021
Accepted: February 19, 2021
Article in press: February 19, 2021
Published online: April 26, 2021
Processing time: 142 Days and 12.7 Hours
Abstract
BACKGROUND

Emphysema pyelonephritis (EPN) is a very dangerous type of urinary tract infection. It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly, and it can easily lead to systemic infections and even sepsis. The incidence is extremely low, and it is prevalent in patients with diabetes. We here report a case of EPN in a non-diabetic patient with autosomal dominant polycystic kidney disease (ADPKD). We share the diagnosis and treatment procedure for this extremely rare condition to make this disease easier to identify and address early.

CASE SUMMARY

A 47-year-old woman presented to the emergency department of our hospital with a high fever and left back pain lasting 4 d. She had a history of autosomal dominant polycystic kidney and polycystic liver. She was diagnosed with left type I EPN and her vital signs deteriorated so quickly that she underwent an emergency operation in which a D-J tube was inserted into her left ureter on the second day after admission. Two months later, she underwent a second-stage flexible ureteroscopy and lithotripsy. Despite postoperative sepsis, she finally recovered after active symptomatic support treatment and effective anti-infective treatment.

CONCLUSION

Although EPN is more likely to occur in diabetic patients, for non-diabetic patients with ADPKD and upper urinary tract obstruction, the disease also causes rapid deterioration. Early and accurate diagnosis and timely removal of the obstruction by invasive means may be able to save the damaged kidney and the patient’s life.

Keywords: Emphysematous pyelonephritis; Necrotizing infection; Autosomal dominant polycystic kidney disease; Flexible ureteroscopy lithotripsy; Endoscopic surgery; Lithotripsy; Case report

Core Tip: Emphysematous pyelonephritis (EPN) is a rare but critical necrotizing infection. Most patients have diabetes, and the incidence of EPN in non-diabetic patients with autosomal dominant polycystic kidney disease (ADPKD) is extremely rare. There are very few published articles about conservative treatment and nephrectomy that are used to treat such patients. We present the clinical case of a 47-year woman who was diagnosed with EPN and multiple renal stones with ADPKD confirmed by a non-contrast computed tomography. The patient was treated successfully with insertion of a double “J” stent followed by a second-stage flexible ureteroscopy and lithotripsy. For non-diabetic patients diagnosed with EPN and ADPKD, it is critical to relieve the combined upper urinary tract obstruction by internal drainage.