Clinical Profile and Outcome of Conservatively Managed Emphysematous Pyelonephritis

Abstract

Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal parenchymal infection characterized by production of intraparenchymal gas. EPN predominantly affects female diabetics and immunocompromised patients. In a three-year period 2008–2011, a total of 8 patients were admitted to our hospital. All of them were diabetics, and both males and females were equally affected. These patients showed vague symptoms at admission and frequently presented with fever, loin pain, dysuria, and pyuria necessitating urgent medical attention. EPN required radiological diagnosis. CT scan revealed bilateral EPN with urinary obstruction and hydronephrosis in 50% of patients. Escherichia coli was found to be the causative organism in all the patients. Treatment comprised of resuscitation, normalization of serum electrolytes and blood sugars, administration of parenteral antibiotics, and relieving ureteric obstruction if present. All the patients improved with conservative management without any mortality.

Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment

“…The first approach is ultrasonography, showing gas in renal or perinephric tissue with dirty shadowing, 5 but the definitive diagnosis test is an abdomen CT. 3 It allows us to assess the extent of renal parenchymal involvement and to determine the patient's response to therapy. 9 The most controversial point of this pathological entity is its management. Early nephrectomy and joint antibiotic therapy were the standard treatment.…”

670 Emphysematous pyelonephritis: Time for a management plan with an evidence based approach

“…1). Full reports were evaluated in 48 studies, of which 32 were included in the systematic review [1][2][3][6][7][8][10][11][12][13][14][15][16][17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Most of the studies were published within the last 10 years, reflecting the increased awareness of EPN and the associated controversy.…”

“…The main focus of treatment is an emergency nephrectomy (EN), percutaneous drainage (PCD), or medical management (MM), with or with no stenting of the urinary tract. Some reports recommend that EN should be the mainstay of treatment and not be delayed [2,3], but others recommended a more conservative approach with PCD [6][7][8], and a purely conservative approach with MM alone has also been advocated [9][10][11], which further increases the management conundrum.…”

Emphysematous pyelonephritis (class IIIa) managed with antibiotics alone

“…Recently, reports of successful management using percutaneous drainage and medical management alone have started coming from across the world even with bilateral and extensive disease. [4][5][6] A recent case series describes eight cases of EPN with medical management alone. 6 Of these eight cases, four were class IV EPN, five cases required haemodialysis, whereas four needed percutaneous drainage.…”