A Case of Acute Multifocal Bacterial Nephritis Associated with Diabetic Autonomic Neuropathy.

Park,  Eun Kyung; Lee,  Jae Hak; Yoon,  Ji Sung; Mok,  Ji O; Kim,  Yeo Joo; Park,  Hyeong Kyu; Kim,  Chul Hee; Kim,  Sang Jin; Byun,  Dong Won; Suh,  Kyo Il; Yoo,  Myung Hi

Case Report

Korean Diabetes Journal 2003;27(4):379-384.
Published online August 1, 2003.

A Case of Acute Multifocal Bacterial Nephritis Associated with Diabetic Autonomic Neuropathy.

Eun Kyung Park, Jae Hak Lee, Ji Sung Yoon, Ji O Mok, Yeo Joo Kim, Hyeong Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo

Department of Internal Medicine, College of Medicine, Soonchunhyang University, Chunan, Korea.

Abstract

Acute multifocal bacterial nephritis is a severe form of acute renal infection in which a heavy leukocytic infiltrate occurs throughout the kidney. It is also an early phase of renal corticomedullary abscess. Clinically, patients have evidence of a severe urinary tract infection secondary to a gram-negative organism and there are frequently signs of sepsis. About half of the reported patients have been diabetics. Urinary tract infections are more common in diabetic women than in non-diabetic women. A variety of factors may contribute. The most important predisposing factor may be bladder dysfunction as a result of diabetic neuropathy and cystopathy. Diabetic cystopathy begins as decreased bladder sensation and decreased reflex detrusor activity caused by neuropathy affecting sympathetic and parasympathetic afferent fibers. Impaired bladder sensation results in bladder distention and increased residual urine volume. Long-term effects may eventually be vesicoureteral reflux and recurrent upper urinary tract infection. However, until now no diabetic patient with acute multifocal bacterial nephritis has been reported in Korea. Acute multifocal bacterial nephritis can be diagnosed by clinical manifestations and on radiologic grounds, including abdominal computed tomography showing multiple, wedge shaped, poorly defined areas of decreased contrast enhancement in multiple renal lobes. Therefore, we report the first Korean case of acute multifocal bacterial nephritis associated with diabetic autonomic neuropathy and review the literatures.

Key Words: Acute multifocal bacterial nephritis, Diabetic autonomic neuropathy