A Case Series of Emphysematous Pyelonephritis

Abstract

Introduction. Emphysematous pyelonephritis (EPN) is an uncommon infection characterized by gas in the renal parenchyma and surrounding tissues. It is rapidly progressive, requiring appropriate therapy to salvage the infected kidney. Case Description. The case series presents 5 patients with a clinical and radiologic diagnosis of EPN. Each patient had a unique predisposing factor for developing EPN. Early goal directed therapy with intravenous fluids and antibiotics was given. This was followed by less invasive urologic interventions in an attempt to avoid nephrectomy and thereby salvage the infected kidney. All five patients were discharged in clinically stable conditions. Discussion and Conclusion. This case series provides added practice based support to available literature for managing EPN. Early goal directed medical therapy for sepsis coupled with interventional urologic procedures is a valuable alternative to circumvent an upfront emergent nephrectomy, except in cases where a fulminant infection may be present at the time of admission or develop later on in the course of the patients illness despite conservative line of therapy. It also highlights the importance of considering a diagnosis of EPN in patients with urinary infections, who have certain common predisposing factors listed in our case series.

Emphysematous Pyelonephritis: a Review of a Rare Condition

“…Microbiologically, E. Coli remains the most common causative organism, with positive cultures identified in over two thirds of reported cases [9]. Other bacteria identified include Klebsiella pneumoniae, Proteus mirabilis, Enterococcus, Pseudomonas, Citrobacter, Streptococcus and Staphylococcus.…”

“…Anaerobic organisms have been cultured including Clostridium and fungi such as Candida. Bacteraemia is reported in approximately 50 % of patients [9][10][11]. Microscopically, the kidney demonstrates gas filled pockets, necrosis, abscess formation, areas of infarction and thrombosis within blood vessels [8].…”

Emphysematous Pyelonephritis with Abscesses Masquerading as an Ordinary Urinary Tract Infection

“…After nephrectomy, she was continued on intravenous antibiotics and then transitioned to oral therapy for an additional week on discharge. Some patients remain on antibiotic therapy after intervention and the duration reported ranges from 10 days to 30 days depending on severity of the illness (Arsene et al, 2014). Oral antibiotics may be continued afterwards for one to three months (Best et al, 1999;Jain et al, 2000;Laway et al, 2012;Tahir et al, 2000).…”

Acute Flank Pain: Multi-detector Computed Tomographic Evaluation in the Emergency Room

“…Emphysematous pyelonephritis is a rare, necrotizing infection characterized by gas production in the renal parenchyma (17). Most patients are diabetic, and obstructive uropathy is reported as a risk factor in 90% in different series.…”