Bilateral Emphysematous Pyelonephritis and Emphysematous Cystitis with Autosomal-Dominant Polycystic Kidney Disease: Is Conservative Management Justified?

Abstract

Objective: To report a case of bilateral emphysematous pyelonephritis (EPN) and emphysematous cystitis in a 64-year-old diabetic male with autosomal-dominant polycystic kidney disease (ADPKD). Case Presentation and Intervention: A 64-year-old diabetic male presented with worsening of renal function and fluid overload. Diagnosis was confirmed by computerized tomography (CT scan) and conservative management with broad-spectrum antibiotics was instituted. There was good clinical response and repeated CT scan showed complete resolution. Conclusion: This case shows that conservative management is an acceptable alternative to surgery in EPN occurring with ADPKD. However, it is recommended that patients should be closely monitored, both clinically and radiologically, and percutaneous catheter drainage or surgical intervention carried out whenever deemed necessary.

Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis

“…Renal replacement therapy was offered, but the patient did not give consent for it. Emphysematous pyelonephritis has rarely been reported to occur in ADPKD both in diabetics and non diabetics [20,21], and the disease has been managed conservatively with good outcomes. Our case with underlying ADPKD had unilateral involvement and responded well to conservative management.…”

Bilateral Extensive Emphysematous Pyelonephritis

“…EPN in our patient was extremely severe and involved both kidneys with dissemination of the gas generated by the pathogen in the urogenital system. Bilateral extensive EPN is rare, yet more life-threatening [2,[5][6][7] . Patients experiencing bilateral EPN with 2 or more indicators for profound sepsis (i.e., thrombocytopenia, acute renal failure, drowsiness and shock) are subject to significantly higher treatment failure rate when treated conservatively with nephrostomy drainage and antibiotic(s) [2] .…”

“…With regards to our patient, the metabolic derangement in general and acute renal failure in particular raised the concern of whether or not he could tolerate an emergency bilateral nephrectomy, hence the decision was made to perform nephrostomy. Effective therapeutic modalities for bilateral EPN remain controversial [2,[5][6][7] . Although conservative treatment alone, type I EPN (renal parenchymal destruction with absence of fluid content or presence of streaky or mottled gas on CT, regardless of the existence of bubbly or loculated gas) [3] , bilateral EPN and thrombocytopenia have each been identified as a significant risk factor for mortality in a meta-analysis [8] , patients with bilateral EPN cured by medical treat- Early percutaneous drainage could reduce bacterial burden, release the gas generated by the culprit pathogen and increase local antibiotic concentration in the inflammatory site leading to enhanced kidney perfusion.…”

Abdominal pain in a female adolescent: answer

“…In our patient, obstructive uropathy, due to a large midpole cyst, was probably present and may have contributed to the onset of EPN. Interestingly, three case reports of bilateral EPN occurred in individuals with ADPKD, one of whom was dialysis dependent [8][9][10], indicating that the occurrence of EPN even in end stage renal disease is possible. Despite the obvious predisposing factors mentioned above, EPN has been reported in an individual with no identifiable risk factors [11].…”

“…Prompt fluid resuscitation, control of hyperglycemia, aggressive IV antimicrobial therapy, and drainage of the abscess cavity are critical in the early management of EPN. Indeed, the availability of potent antimicrobials, widespread availability of CT apparatus, and interventional radiological techniques are credited for the significant reduction in mortality and successful nephron-sparing management among EPN patients, even those with class 4 EPN [6,9,10]. However nephrectomy may still be indicated, if conservative management fails.…”