Emphysematous pyelonephritis

Abstract

A BSTRACT Urinary tract infections are commonly encountered and managed worldwide, and emphysematous pyelonephritis (EPN) is among the most serious types of urinary tract infections. EPN is an acute necrotizing infection of the kidney, often associated with high rates of renal loss and mortality. The symptoms of EPN infection can be nonspecific, but the clinical triad of fever, flank pain, and nausea represent the most common presentations. The diagnosis and classification are performed with the assistance of computed tomography (CT). The imaging-based classification system created by Huang and Tseng is widely used in clinical assessments. They defined EPN into four different class (1–4), with the higher number the more severe disease. Optimal EPN treatment is controversial, with emergent nephrectomy suggested during early studies, whereas more recent evidence favors more conservative approaches. Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis are most common pathogens. The initial use of broad-spectrum antibiotics such as Third-or fourth-generation cephalosporins and carbapenems are recommended. Diabetes, obstructive uropathy and hypertension are the most common risk factors and often need treatment together. Emergent drainage is indicated with a larger-sized drainage tube to achieve better drainage function. CT guidance has a better success rate than insertion under the guidance of ultrasonography. Nephrectomy should be reserved as the last resort for those who fail to respond to conservative therapy. This review aims to provide comprehensive, evidence-based recommendations for the diagnosis and management of this life-threatening urological infection.

Mucosal emphysematous head and neck infections: Scoping review and a case of emphysematous tonsillitis

“…Outside of the head and neck, emphysematous infections of the abdomen and pelvis carry a high risk of mortality, between 10% and 50%. 6 , 7 , 8 …”

“…The most common organisms involved are Escherichia coli, Klebsiella pneumoniae , Proteus mirabilis , Clostridium perfringens , and S taphylococcus aureus . 5 , 6 , 7 , 8 Cases of emphysematous infections due to Candida albicans and Pseudomonas aeruginosa have also been reported. 8 , 9 , 10 , 11 , 12 Patients with poorly controlled diabetes and immunocompromised patients are at higher risk but many cases occur in immunocompetent individuals.…”

Case report on bilateral emphysematous pyelonephritis in a non-diabetic male: A complex treatment journey

“…Emphysematous pyelonephritis (EPN) is a serious kidney infection characterized by acute necrotizing infection in the renal tissue and nearby structures [ 3 ]. EPN infection can have nonspecific symptoms, but the most common clinical presentation includes a triad of fever, flank pain, and nausea [ 3 ].…”

“…Emphysematous pyelonephritis (EPN) is a serious kidney infection characterized by acute necrotizing infection in the renal tissue and nearby structures [ 3 ]. EPN infection can have nonspecific symptoms, but the most common clinical presentation includes a triad of fever, flank pain, and nausea [ 3 ]. Blood test abnormalities often seen in EPN patients include leukocytosis, thrombocytopenia, elevated creatinine levels, high C-reactive protein levels, or hypoalbuminemia [ 3 ].…”

In Response to "Emphysematous Urinary Tract Infections in Diabetics"

“…For patients with poorly controlled EPN, especially those with Grade 3 or Grade 4 severity, subsequent nephrectomy may still be necessary if medical therapy and PCD prove ineffective. 5 The prognosis of EPN is influenced by various factors. Numerous studies have demonstrated that certain initial presentations are significantly associated with mortality.…”