集学的治療が奏効した結石性腎盂腎炎による敗血症性ショック

A case of effective multidisciplinary therapy for septic shock due to acute pyelonephritis

症例は72歳男性，2型糖尿病を合併していた。発熱と呼吸苦を主訴に受診し，急性腎不全，左尿管結石に伴う水腎症，敗血症ショックのため，全身管理目的で集中治療室に入室となった。尿管ステント留置後に，敗血症に対してSSCG（Surviving Sepsis Campaign Guidelines）2008に沿った治療を開始した。人工呼吸器管理にてエンドトキシン吸着と持続的血液濾過透析も併用し，循環動態が安定化した。入院7日目に全身状態が改善したため集中治療室を退室した。集学的治療により救命し得た1例であった。

A 72-year-old man with type 2 diabetes mellitus was admitted to our hospital because of fever and dyspnea. The patient was diagnosed as acute renal failure,hydronephrosis due to a left ureteral stone,and sepsis caused by acute pyelonephritis. He received not only management of systemic inflammatory response syndrome,but also drainage of the source of infection and blood purification therapy focused on endotoxin absorption. His hemodynamics were markedly stabilized,and he become clinically improved. These results indicate that multidisciplinary therapy including endotoxin absorption should be considered for patients with sepsis secondary to urinary infection.