Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of high-grade fever, rigors, and severe flank pain. History significant for poorly controlled diabetes mellitus. Symptoms include dysuria, frequency, and malaise. No history of recent instrumentation or trauma. Patient appears toxic, with signs of systemic inflammatory response syndrome (SIRS).
Clinical Examination Findings
Vitals: Tachycardic, tachypneic, febrile, hypotensive. Abdominal exam: Marked costovertebral angle (CVA) tenderness on the affected side, guarding, and rebound tenderness. Skin: Possible subcutaneous emphysema in severe cases. Neurological: Altered mental status may be present due to sepsis.
Treatment Protocol
Immediate resuscitation with IV fluids and broad-spectrum antibiotics. Urgent CT scan of the abdomen/pelvis to confirm gas in the renal parenchyma/perirenal space (Huang classification). Surgical consultation for urgent percutaneous nephrostomy (PCN) or nephrectomy depending on the extent of gas and patient stability. Glycemic control is mandatory.