CAJ | 학술논문

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。
목적：탐토기종성신우신염( emphysematous pyelonephritis, EPN)적림상진단여감별진단요점,이방범오진。방법대1례당뇨병병EPN적림상자료진행회고성분석병복습상관문헌。결과본례이요복통、고열위수발증상취진,외원의진위급성신우신염,여항감염치료무효입아원。경감측혈당、뇨동체급행쌍신CT검사진단위당뇨병동증산중독、EPN,여항감염、공제혈당、규정당뇨병동증산중독급대증지지치료,동시재초성인도하행경피신천자치관인류,1 d후증상즉완해,8 d후CT검사시신장적기적액소실,11 d후혈뇨상규급신공능회복정상。결론 EPN위급위중증,림상교위소견,역오진。림상응가강대EPN CT영상특점적인식,이기조진단병치료。
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.