A prospective study of emphysematous pyelonephritis in patients with type 2 diabetes

Abstract

Introduction: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma. There is a lack of studies on follow up of EPN patients. The study aimed to explore the effect of EPN in patients with type 2 diabetes (T2D) on glycemic and renal parameters on follow up, and factors suggesting the failure of medical treatment. Methods: This was a hospital-based prospective study done over a period of 3 years on newly diagnosed consecutive 20 patients of emphysematous pyelonephritis (EPN) with T2D. Study analyzed the clinical, laboratory, radiological, microbiological findings, complications, treatment modality, and outcome. All patients were followed up for 6 months with respect to the number of urinary tract infections (UTIs), glycemic control, and renal parameters. Results: Most of the patients were postmenopausal females with longer duration of diabetes and complicated by triopathy. Fever and renal angle tenderness were the most common clinical finding. The majority of our patients 12 (60%) had EPN (class 1 and 2). Severe hyperglycemia was present in 19 (95%), hyperosmolar hyperglycemic state (HHS) in 5 (25%), diabetic ketoacidosis (DKA) in 3 (15%), and acute kidney injury (AKI) in 15 (75%). Bacteriuria was present in 90% and bacteremia in 30%. E. coli was the most common organism isolated (80%). The survival rate was 90%, with failure of medical treatment in 30%. Renal obstruction and worsening azotemia predicted the failure of medical management. The significant number (11, 55%) of patients developed recurrent UTI on follow up. Factors that increased the risk of recurrent UTI in EPN were chronic kidney disease, poor glycemia, and renal obstruction. The recurrent UTI patients had significantly higher glycosylated hemoglobin A1c (HbA1c) at follow up than at baseline, but renal parameters did not differ. Conclusions: We recommend early aggressive medical treatment of EPN. Altered sensorium, renal obstruction, and deteriorating renal function may suggest the failure of medical treatment.

A Rare Case of Emphysematous Pyelonephritis in a Non-diabetic Patient With Staghorn Calculus

“…The exact pathophysiology of EPN remains unclear, but it is strongly linked to bacterial infections, primarily caused by gram-negative and anaerobic bacteria such as Escherichia coli , Klebsiella pneumoniae , Proteus mirabilis , and Pseudomonas aeruginosa [ 1 ]. In patients with diabetes mellitus, uncontrolled blood sugar levels, elevated glycosylated hemoglobin levels, and compromised immune function may contribute to the development and severity of EPN [ 2 ]. These factors underscore the importance of managing diabetes and promptly treating urinary tract infections to prevent the onset of EPN.…”

“…Emphysematous pyelonephritis (EPN) is a rapidly progressive and potentially life-threatening condition primarily affecting individuals with type 1 and type 2 diabetes, particularly more prevalent among females [ 1 , 2 ]. This condition is characterized by necrosis of renal parenchyma accompanied by the presence of gas within the urinary system, renal tissue, and adjacent areas [ 3 ].…”

An Atypical Presentation of Emphysematous Pyelonephritis Complicated by Methicillin-Resistant Staphylococcus aureus Bacteremia

“…Third-generation cephalosporins, aminoglycosides, and fluoroquinolones are first-line antimicrobials for conservative management of EP. In cases of EP complicated by MRSA bacteremia and septic shock, conservative antibiosis strategies should include vancomycin to cover this species [ 20 ]. Urgent urology consultation and percutaneous drainage, followed by delayed nephrectomy in the case of a nonfunctioning kidney, is presently the gold standard for the management of EP in conjunction with conservative management [ 17 ].…”