Bilateral Extensive Emphysematous Pyelonephritis

Abstract

Objective: We report a case involving a patient with bi- lateral emphysematous pyelonephritis (EPN) who was successfully treated with antibiotics and nephrostomy sparing nephrectomy. Case Presentation and Intervention: A 54-year-old diabetic man presented with the chief complaint of progressive abdominal pain for 10 days. Blood tests indicated acute renal failure and hyperglycemic hyperosmolar state. An abdominal radiograph disclosed gas distributed over regions where the bilateral kidneys are located and the right para-lumbosacral area. Computed tomography revealed bilateral enlarged kidneys with the presence of gas in the renal parenchyma and renal pelvis, left peri-renal space, bilateral ureter, bladder, prostate gland and right scrotum. Cultures of urine and blood grew Escherichia coli. The patient was successfully treated with antibiotics coupled with nephrostomy. Conclusion: Timely recognition and initiation of effective antibiotic therapy and nephrostomy may cure the patient with bilateral EPN, while sparing nephrectomy. Regarding clinical manifestations, EPN is nonspecific; hence, radiographs should be taken for diabetic patients with abdominal pain (especially those with poorly controlled blood sugar) to enable early diagnosis of potential EPN.

Successful management of bilateral emphysematous pyelonephritis in end-stage polycystic kidneys: bilateral native nephrectomies and preservation of functioning renal transplant

“…An extensive review [ 4 ] suggests that mortality rates in patients having percutaneous drainage is favourable (13.5%) compared to nephrectomy (25%) and conservative treatment (50%). A scenario where a non-surgical approach may be particularly favoured is in bilateral EPN [ 6 , 7 ] or in EPN within a functioning transplant [ 8 – 10 ]. Successful conservative or percutaneous drainage could preserve the functioning renal unit.…”