Emphysematous Pyelonephritis: Drainage or Nephrectomy?

Koh, K. B. H.; Lam, H.; Lee, S. H.

doi:10.1111/j.1464-410x.1993.tb16036.x

Cited by 34 publications

(16 citation statements)

References 12 publications

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“…Combined medical therapy with nephrectomy has been advocated by many authors [1,14] , but conservative treatment has been recommended by others [8,[15][16][17] . However, percutaneous drainage combined with medical treatment has been reported to produce complete recovery in a few cases [8] .…”

Section: Discussionmentioning

confidence: 99%

Severe Emphysematous Pyelonephritis in Diabetic Patients

Abdul-Halim

Kehinde²,

Abdeen³

et al. 2005

Urol Int

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Purpose: Emphysematous pyelonephritis (EPN) is a rare, severe gas-forming infection of renal parenchyma and surrounding tissues seen mostly in diabetic patients. Diagnosis and adequate therapeutic regimen are controversial. We reviewed the clinical presentation, diagnosis and aspects of surgical management of patients presenting with severe EPN. Patients and Methods: Patients with EPN managed in our unit between 1996 and 2004 were reviewed. Diagnosis was confirmed by CT scan appearance of gas in the renal or perirenal area in a very ill patient. We compared the outcome of immediate nephrectomy with drainage of perinephric abscesses in patients presenting with severe EPN. Results: Seven patients were managed in our unit during the 8-year period. All patients were diabetic and women outnumbered men (6:1). Renogram in all 7 patients showed renal function of affected kidney to be less than 15% in 6 patients. Escherichia coli was isolated in all patients from either urine, blood or perinephric pus. Management consisted of intensive resuscitation, control of blood glucose and use of intravenous antibiotics. Emergency nephrectomy was performed in 3 patients, delayed nephrectomy after an initial period of percutaneous drainage in 2 patients, incision and drainage in one patient and immediate percutaneous drainage was performed in one patient. One patient died 5 days post-nephrectomy of myocardial infarction. Patients who had immediate nephrectomy recovered quicker (18–21 days) and had no postoperative complications. Patients who had incision and drainage, or percutaneous drainage presented with recurrent discharging sinuses or perinephric abscesses requiring further surgical interventions and spent longer time in hospital (28–37 days). Conclusion: Patients with severe EPN often present in extremis and require intensive medical treatment. The diagnosis must be entertained in diabetic women presenting with flank pain and septicemia. The function of the affected kidney is often very poor and early nephrectomy offers the best outcome. Percutaneous drainage or incision and drainage of the abscess may be performed in patients too ill for immediate formal nephrectomy.

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Section: Discussionmentioning

confidence: 99%

Severe Emphysematous Pyelonephritis in Diabetic Patients

Abdul-Halim

Kehinde²,

Abdeen³

et al. 2005

Urol Int

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“…There is no correlation between patient outcome and degree of gas production in the literature [8]. Conservative or percutaneous drainage management was not appropriate in our case because the renal parenchyma was involved in addition to the renal compartment and glomerular filtration was decreased [2,9].…”

Section: Discussionmentioning

confidence: 80%

Emphysematous pyelonephritis related to specific gas-forming Escherichia coli without diabetes mellitus

Hazouard

Barat

Lanotte

et al. 1999

Intensive Care Medicine

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A 60-year-old-man without a history of diabetes mellitus, or invasive manipulation or obstruction of the urinary tract was admitted for septic shock. Type I emphysematous pyelonephritis was clear in this case: gas within the renal parenchyma extending into the subcapsular region and the perirenal space was present on spiral computerised tomography (CT). Surgical nephrectomy was performed because biochemistry, urography and CT identified a damaged non-functioning left kidney. The outcome was favourable. All urine, blood and nephrectomy specimen cultures were positive for a specific Escherichia coli which produced a high level of gas compared to a reference E. coli strain in the same standard medium, despite the absence of diabetes mellitus. Certain strains of bacteria are able to produce high levels of nitrogen, carbon dioxide and hydrogen and such fermentation in the absence of a high glucose serum level might explain the acute gas-producing bacterial renal infection.

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Aboumarzouk¹,

Zreik²,

Hughes³

et al. 2014

European Urology Supplements

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Introduction: Emphysematous pyelonephritis (EPN) is a life-threatening necrotising kidney infection, but there is no consensus on the best management.Methods: We systematically reviewed previous articles published from 1980 to 2013 that included studies reporting on EPN, and applying the Cochrane guidelines, we conducted a meta-analysis of the results.Results: In all, 32 studies were included, with results for 628 patients (mean age 56.6 years, range 33.8-79.9). There were 462 women, outnumbering men by 3:1. Diabetes was present in 85% of the cases. Fevers and rigor (74.7%), pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was associated with 54.4% of deaths while obstructive uropathy was associated with 15.1% of deaths. Computed tomography was diagnostic in all the cases. Percutaneous drainage (PCD) and medical management (MM) alone were associated with a significantly lower mortality rate than was emergency nephrectomy (EN), with an odds ratio (95% confidence interval) for PCD vs. EN of 3.13 (1.89-5.16; P < 0.001), for EN vs. MM of 2.84 (1.62-4.99; P = 0.001), and of 0.91 (0.53-1.56; P = 0.73, i.e., no difference) for * Corresponding author. Tel.: +44 7886885677. E-mail address: aboumarzouk@gmail.com (O.M. Aboumarzouk). Peer review under responsibility of Arab Association of Urology. Production and hosting by ElsevierArab Journal of Urology (2014) PCD vs. MM. Open drainage also had a significantly lower mortality rate than EN, with a ratio of 0.12 (0.02-0.91; P < 0.04).Conclusion: The overall mortality rate was %18%; shock was associated with a high mortality rate and therefore should be managed aggressively. PCD and MM were associated with significantly higher survival rates than EN, and therefore EN should only be considered if the patient does not improve despite other treatments. ª 2013 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology.

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Emphysematous Pyelonephritis: Drainage or Nephrectomy?

Cited by 34 publications

References 12 publications

Severe Emphysematous Pyelonephritis in Diabetic Patients

Severe Emphysematous Pyelonephritis in Diabetic Patients

Emphysematous pyelonephritis related to specific gas-forming Escherichia coli without diabetes mellitus

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

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