A Case of Diabetic Ketoacidosis and Pyonephrosisin Diabetic Patient with Asymptomatic Bacteriuria

Lee, Sung Hyuk; Kim, Hyo Jeong; Koo, Bo Kyung; Min, Kyung Wan; Jung, Jun Young; Song, Eun Ju; Lee, Seung Wook; Han, Kyung Ah

Case Report

The Journal of Korean Diabetes 2008;9(4):341-345.

무증상 세균뇨가 있던 당뇨병환자에서 발생한 농신증과 당뇨병성 케톤산증 1예

이성혁, 김효정, 구보경, 민경완, 정준영, 송은주, 이승욱, 한경아

A Case of Diabetic Ketoacidosis and Pyonephrosisin Diabetic Patient with Asymptomatic Bacteriuria

Sung Hyuk Lee, Hyo Jeong Kim, Bo Kyung Koo, Kyung Wan Min, Jun Young Jung, Eun Ju Song, Seung Wook Lee, Kyung Ah Han

Abstract

We reported a case of type 2 diabetic woman with asymptomatic bacteriuria who developed pyonephrosis after discontinuation of oral hypoglycemic agents, which resulted in diabetic ketoacidosis and septic shock. Clinical symptoms and signs of patient were improved after urgent decompression of dilated collecting system with drainage of pus. Pyonephrosis is difficult to discriminate from general urinary tract infection (UTI) in the early stage of disease by symptom, sign or laboratory finding. Therefore pyonephrosis is known to be fatal when the diagnosis is delayed. For the present, imaging study is not generally recommended for the diagnosis of uncomplicated urinary tract infection. However this case implicated that patients with diabetes, regardless of their present illness, were highly suspicious for the presence of complicated infection and imaging study might be considered as initial evaluation. (KOREAN CLINICAL DIABETES J 9:341-345, 2008)

Key Words: Diabetes, Pyonephrosis