馬蹄腎合併產氣性腎盂腎炎：病例報告

李琇碧、高偉棠

衛生福利部雙和醫院 泌尿科

Emphysematous Pyelonephritis in a Horseshoe Kidney: A Case Report

Siou-bi Li, Wei-Tang Kao

Department of Urology, Shuang Ho hospital, Taipei Medical University, Taipei, Taiwan

Introduction: Emphysematous pyelonephritis (EPN) is a severe, gas-forming necrotizing renal infection predominantly affecting diabetics. Its occurrence in a horseshoe kidney—an anomaly predisposed to urinary stasis and nephrolithiasis—is exceedingly rare. We report a case of EPN in a horseshoe kidney successfully managed with percutaneous nephrostomy (PCN) and antibiotic therapy.

Case description: A 54-year-old bedridden male with type 2 diabetes and prior intracerebral hemorrhage presented to the Emergency Department with a two-day history of left upper abdominal pain, dysuria, and fever. Laboratory evaluation revealed leukocytosis, acute kidney injury, elevated inflammatory markers, and elevated lactate. Urinalysis demonstrated gross hematuria, pyuria, bacteriuria, and glycosuria. Computed tomography revealed a horseshoe kidney and left emphysematous pyelonephritis, accompanied by a small left renal stone and hydronephrosis. The patient developed septic shock with hypotension and desaturation, requiring intubation and fluid resuscitation. Management included empiric broad-spectrum antibiotic and emergent PCN drainage. Following clinical stabilization and improvement in renal function, a double-J stent was placed and the PCN was removed. The patient was later discharged in stable condition.

Discussion: The coexistence of EPN and horseshoe kidney is clinically rare. Horseshoe kidneys are anatomically prone to urinary stasis and infection due to high ureter insertion and its angulation over the isthmus. In diabetics, hyperglycemia and impaired tissue perfusion create an ideal environment for gas-forming organisms. Historically, emergency nephrectomy was the treatment of choice for EPN but was associated with high mortality (up to 40-50%). In recent years, broad-spectrum antibiotic therapy and percutaneous drainage have shown significantly reduced mortality rates. This case demonstrates that even in the presence of septic shock—a poor prognostic factor—aggressive resuscitation combined with minimally invasive drainage can successfully resolve EPN and preserve renal function.

Conclusion: This case highlights the importance of early diagnosis and timely minimally invasive decompression for emphysematous pyelonephritis in diabetic patients, especially those with congenital renal anomalies.