ĐẶC ĐIỂM LÂM SÀNG VÀ CẬN LÂM SÀNG CỦA BỆNH VIÊM THẬN BỂ THẬN SINH KHÍ TẠI BỆNH VIỆN CHỢ RẪY

Abstract

Background and Objective: Emphysematous pyelonephritis (EPN) is an acute severe, necrotizing infection of the renal parenchyma and its surrounding tissues that is characterized by the gas formation within the renal parenchyma, collecting system, or perinephric tissue. This gaseous component, carbon dioxide, is produced from glucose by the bacterial fermentation. Although patients with EPN show relatively vague symptoms initially, but  there is often a sudden deterioration in general condition, requiring early diagnosis and promt aggressive treatment. This study aimed in clinical and subclinical characteristics of EPN at Cho Ray hospital. Patients and Methods: Retrospectively descriptive case series of EPN  was performed at Cho Ray hospital from January, 2011 to December, 2019. Results: From January 2011 to December 2019, there were 176 cases of EPN at Cho Ray hospital. The median age is 59 (51-67.5). The majority was female 143 cases (81.2%). Common clinical symptoms include flank pain 166 cases (94.3%) and fever 153 cases (86.9%). There were 127 cases (72.2%) had diabetes mellitus, and 109 patients (62%) had urinary tract obstruction. At hospital admission, there were 35 cases of consciousness disorder (19.9%), 68 cases (38.6%) of sepsis, 41 cases (23.3%) of septic shock and 71 cases (40.3%) of acute kidney injury. There were 52 cases (29.5%) of thrombocytopenia. Signs of EPN  in echogram and KUB were reported in 22.8% and 13.7%, respectively. Class 3 and 4 EPN  had 108 cases (61.4%). There were 45.5% and 50,6% of cases presented the infection on the left and right side, respectively. Seven  cases (4%) had infection in both side kidney. Conclusion: EPN is an acute serious urinary tract infection required early diagnosis and promt aggressive treatment. CT scan is the gold standard in diagnosis of EPN. Management depends on individuals’ comorbidities and classification.