A rare presentation of diabetes with severe kidney infection

Case of the Week: Department of Nephrology

Type 2 Diabetes first time presenting as pyelonephritis

What is Pyelonephritis?

A type of urinary tract infection, Pyelonephritis is where one or both kidneys of a person gets infected. This can be due to bacteria or a virus. It can cause people to feel very sick and require treatment.

Pyelonephritis can be life-threatening. When repeated or persistent attacks occur, the condition is called chronic pyelonephritis. The chronic form is rare, but it happens more often in children or people with urinary obstructions.

An Interesting Case of Pyelonephritis at Aadicura Superspeciality Hospital.

A 42-year-old female presented with a complaint of an episode of fever, chills and flank pain a week ago. Her regular physician suggested a urinary infection and started antibiotic treatment. With no effect from the same, she was referred to Aadicura Superspeciality Hospital where with the combined team efforts of the nephrology and endocrinology specialists, the patient was relieved of the pain.

How was she treated?
A 42-year-old female patient complained of an episode of fever, chills and flank pain. She also complained of excess weakness, for which she consulted her regular physician. She was given a dose of antibiotics and suggested a urinary infection. The patient was referred to Aadicura Superspeciality Hospital with no effect after taking the prescribed medication.

On the evaluation of her CT KUB (Computed tomography of kidneys, ureters and bladder), it showed an enlargement in the left kidney and suggested pyelonephritis. The urine test had pyuria and TLC around 13000/mL. Since she did not represent any apparent anatomical abnormality that could lead to pyelonephritis, she was evaluated for diabetes. Her RBS was detected for 210 mg/dl and HBA1c showed the presence of diabetes.

Our endocrinologist initiated her with doses of Empirical Piperacillin Tazobactam insulin and continued with a view of sterile urine culture. The patient improved symptomatically and was discharged within 4 days with IV antibiotics.

It is rare for a diabetes patient to present for the first time with pyelonephritis. This case directed us to search for all the risk factors in any patient with urinary infection.

LOOKING FOR A TREATMENT?
Pyelonephritis can be a serious condition. One can contact Dr. Dhaval Khetia, a nephrologist at the department of Nephrology, Aadicura Superspeciality Hospital as soon as you suspect that you have pyelonephritis or a UTI. This condition requires prompt medical attention, so the earlier one starts the treatment, the better.

FILTERING YOUR BODY WELL TO KEEP YOU HEALTHY.
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