Acute pyelonephritis in diabetes mellitus

Resumo

The authors present treatment policy in acute pyelonephritis (AP) associated with diabetus mellitus (DM) and analyse treatment efficacy basing on the material on 214 patients. A clinical course of AP in the presence of DM has some specific features. The disease manifests primarily with clinico-laboratory signs of DM decompensation. Lack of insulin therapy effect in DM decompensated patients indirectly points to acute, especially purulent, pyelonephritis. High temperature, abnormal leukocytic blood picture, leukocyturia, hypercreatininemia in patients with insulin-resistent DM demands urological examination. Renal and urinary pathology is prompted by x-ray picture of atonic
dilation of the caliculopelvic system and ureter in neuropathy. Vesicoureteral reflux, tower-like deformation of the urinary bladder, ureterohydronephrosis in DM patients are readily diagnosed with cystography, excretory urography and ultrasonic investigation. Therapeutic policy must be based on pyelonephritis form, severity of DM and efficacy of conservative therapy. No response to therapy, increasing academia and intoxication show failure of conservative treatment and absolute necessity of surgery. In extended purulent acute pyelonephritis preference is given to primary nephrectomy. The differentiated policy of acute pyelonephritis treatment led to DM remission and therapeutic response in 84.6% patients. Total lethality was 15.4%. Its cause was a severe condition of the patients.