| Theme |
Fatal infections of elderly and super-elderly dialysis patients |
| Title |
Urological infectious disease : Emphysematous pyelonephritis/cystitis and pyonephrosis |
| Author |
Masaharu Nishikido |
Division of Blood Purification, Nagasaki University Hospital |
| Author |
Mineaki Kitamura |
Division of Blood Purification, Nagasaki University Hospital |
| Author |
Satoko Kitamura |
Division of Blood Purification, Nagasaki University Hospital |
| Author |
Hideki Sakai |
Department of Urology and Renal Transplantation, Nagasaki University Hospital |
| Author |
Takashi Harada |
Nagasaki Kidney Hospital |
| [ Summary ] |
Emphysematous pyelonephritis/cystitis and pyonephrosis are rare and life-threatening urinary tract infections, of which diabetes and urinary tract obstruction are risk factors. In old patients and in patients with diabetes who are undergoing dialysis, neurogenic bladder and urinary tract obstruction are often overlooked. Furthermore, many other factors (i.e., uremia-related immune defect, inadequate bacterial washout by urine flow, atherosclerosis, and frail state) may enhance the progression of these diseases in old patients undergoing dialysis.
Therefore, we should understand the implication of the coexistence of these diseases in patients with symptomatic urinary tract infection undergoing dialysis. Computed tomography (CT) is useful in diagnosing and determining the extent of lesion. Early detection by CT and early treatment (including appropriate antibiotics, good glycemic control, urinary drainage, etc.) are important in preventing the aggravation of the condition. |