BACKGROUND The management of emphysematous pyelonephritis (EPN) includes conservative medical treatment, percutaneous drainage, and surgical resection of the involved kidney. EPN with diabetic ketoacidosis(DKA) is very rare, in which the clinical management of refusing surgical drainage is inexperienced. CASE PRESENTATION A 34-year-old woman presented with abdominal pain, chills, fever, nausea, vomiting, chest tightness, and shortness of breath. Blood test results were consistent with diabetic ketoacidosis. Urinary computed tomography scan showed multiple stones in the right kidney and lower ureter, with right hydronephrosis. Blood culture demonstrated Escherichia coli bacteremia, and EPN was diagnosed. Considering the need for a second percutaneous nephrolithotomy, the patient refused percutaneous drainage. After continuous intravenous infusion of small doses of insulin and antibiotic treatment, the ketoacidosis resolved. The patient's temperature returned to normal and abdominal pain was alleviated, and liver and kidney functions were also back to normal. After hospital discharge, the patient underwent two percutaneous nephrolithotomy in the department of urology. CONCLUSIONS EPN with diabetic ketoacidosis should be diagnosed as soon as possible. For patients with Class 1 and Class 2 EPN with diabetic ketoacidosis and urinary tract obstruction, if surgical drainage is refused, it is particularly important to rapidly correct diabetic ketoacidosis and intravenous use of sensitive antibiotics, so as to create conditions for follow-up percutaneous nephrolithotomy.

中文翻译：

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糖尿病酮症酸中毒并发气肿性肾盂肾炎：一例报道并文献复习。

背景技术气肿性肾盂肾炎（EPN）的管理包括保守的药物治疗，经皮引流和受累肾脏的手术切除。EPN合并糖尿病酮症酸中毒（DKA）的情况非常罕见，其中缺乏拒绝手术引流的临床管理经验。病例介绍一名34岁的妇女表现出腹痛，发冷，发烧，恶心，呕吐，胸闷和呼吸急促。验血结果与糖尿病酮症酸中毒相符。尿电脑断层扫描显示右肾和下输尿管有多处结石，并伴有右肾积水。血液培养显示出大肠杆菌菌血症，并诊断出EPN。考虑到需要第二次经皮肾镜取石术，患者拒绝了经皮引流。在连续静脉内小剂量胰岛素输注和抗生素治疗后，酮症酸中毒得以解决。患者的体温恢复正常，腹痛得到缓解，肝肾功能也恢复正常。出院后，患者在泌尿科进行了两次经皮肾镜取石术。结论EPN合并糖尿病性酮症酸中毒应尽快诊断。对于1级和2级EPN合并糖尿病性酮症酸中毒和尿路梗阻的患者，如果拒绝手术引流，迅速纠正糖尿病性酮症酸中毒和静脉内使用敏感的抗生素特别重要，以便为后续经皮肾镜取石术创造条件。患者的体温恢复正常，腹痛得到缓解，肝肾功能也恢复正常。出院后，患者在泌尿科进行了两次经皮肾镜取石术。结论EPN合并糖尿病性酮症酸中毒应尽快诊断。对于1级和2级EPN合并糖尿病性酮症酸中毒和尿路梗阻的患者，如果拒绝手术引流，迅速纠正糖尿病性酮症酸中毒和静脉内使用敏感的抗生素特别重要，以便为后续经皮肾镜取石术创造条件。患者的体温恢复正常，腹痛得到缓解，肝肾功能也恢复正常。出院后，患者在泌尿科进行了两次经皮肾镜取石术。结论EPN合并糖尿病性酮症酸中毒应尽快诊断。对于1级和2级EPN合并糖尿病性酮症酸中毒和尿路梗阻的患者，如果拒绝手术引流，迅速纠正糖尿病性酮症酸中毒和静脉内使用敏感的抗生素特别重要，以便为后续经皮肾镜取石术创造条件。该患者在泌尿科接受了两次经皮肾镜取石术。结论EPN合并糖尿病性酮症酸中毒应尽快诊断。对于1级和2级EPN合并糖尿病性酮症酸中毒和尿路梗阻的患者，如果拒绝手术引流，迅速纠正糖尿病性酮症酸中毒和静脉内使用敏感的抗生素特别重要，以便为后续经皮肾镜取石术创造条件。该患者在泌尿科接受了两次经皮肾镜取石术。结论EPN合并糖尿病性酮症酸中毒应尽快诊断。对于1级和2级EPN合并糖尿病性酮症酸中毒和尿路梗阻的患者，如果拒绝手术引流，迅速纠正糖尿病性酮症酸中毒和静脉内使用敏感的抗生素特别重要，以便为后续经皮肾镜取石术创造条件。