Emphysematous pyelonephritis: Outcome with conservative management

Bhat, RA; Khan, Imran Ali; Palla, Nazir Ahmad; Mir, Toufeeq Ahmad

doi:10.4103/0971-4065.120343

Cited by 15 publications

(26 citation statements)

References 8 publications

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“…In contrast, other studies suggested that PCD is a quite effective and adequate approach with a high success rate even in extensive EPN. [ 3 4 11 12 13 14 15 16 22 23 ] which is in accordance with our study where patients managed conservatively had a good outcome and survived. Furthermore, two patients with class I and class IV treated primarily with DJ stent showed improvement similar to those treated with nephrostomy.…”

Section: Discussionsupporting

confidence: 92%

“…[ 3 ] Furthermore, it is commonly seen in patients with obstructive uropathy, polycystic kidney, and end-stage renal disease. [ 4 ] With a mortality rate of 25%;[ 5 ] it is considered life-threatening, which, necessitates early and aggressive management. [ 6 ] The management can be classified into: Conservative which includes medical and minimally invasive procedures, such as percutaneous drainage (PCD) (nephrostomy) or double J (DJ) stent, and surgical which is nephrectomy.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the morbidity and mortality of EPN [ 5 7 8 ] there is still conflicting reports regarding the most appropriate management. [ 1 3 4 6 9 10 11 12 13 14 15 16 17 18 ] Early interference with nephrectomy was almost a mandatory approach due to increased mortality with medical therapy favoring interventional approach, leaving PCD for inoperable cases. [ 1 6 9 10 17 18 ] This approach has been changed recently due to early detection of patients with EPN with the aid of advanced radiological modalities, alongside early management with potent antibiotics, reserving nephrectomy for patients refractory to conservative measures.…”

Section: Introductionmentioning

confidence: 99%

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Emphysematous pyelonephritis: Is nephrectomy warranted?

et al. 2015

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Introduction:Emphysematous pyelonephritis (EPN) is associated with high mortality rate, up to 25%. There is still conflicting reports regarding the most appropriate management, conservative versus nephrectomy.Objective:To describe the outcome of patients with EPN.Methods:We retrospectively reviewed the medical records of patients diagnosed with EPN by computed tomography from three tertiary institutes in Jeddah, Saudi Arabia. Type of management was classified as conservative and surgical. The conservative includes medical and minimally invasive procedures, such as percutaneous drainage and nephrostomy. The surgical which is nephrectomy. The outcome observed was preservation of the kidney function or patient's life.Results:A total of 10 patients were included (9 females and 1 male), median age was 55 years and 63% were diabetic. The most common presentation was flank pain (100%), fever (75%), and vomiting (63%). The most common organism isolated was Escherichia coli. Nephrectomy was not associated with increased survival rate, while conservative management was associated with a good outcome, less morbidity (not dialysis-dependent).Conclusion:Nephrectomy was not associated with high survival rate. Patients managed conservatively had a better overall performance and better survival. This study will add to other studies, which are encouraging conservative management.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Emphysematous pyelonephritis: Is nephrectomy warranted?

et al. 2015

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“…11 However there are growing reports of successful medical treatment of EPN. [12][13][14][15] According to these reports, our case could be considered treatable by antibiotics alone partly because of the rapid diagnosis and the adequate therapy provided.…”

Section: Discussionmentioning

confidence: 99%

Emphysematous pyelonephritis: a case report

et al. 2015

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Emphysematous pyelonephritis (EPN) is an acute severe necrotizing infection of the renal parenchyma and its surrounding areas, characterized by the presence of gas within the kidney and perinephric tissue. 1 It occurs almost exclusively in patients with diabetes mellitus.2,3 The disease predominantly affects women. Escherichia coli is the causative bacterial source in approximately 70% of the cases, with Klebsiella, Candida and Pseudomonas species less frequently isolated.4,5 Gas formation in EPN is due to pathogenic bacteria causing mixed acid fermentation in a hyperglycemic environment in tissues that are ischemic. The clinical manifestations are those of pyelonephritis such as dysuria, fever, nausea, vomiting, flank pain. Other potential clinical manifestations include acute renal dysfunction, hyperglycemia, thrombocytopenia, lethargy, acid-base irregularities. EPN is a life-threatening disease associated with septic complications. EPN requires a radiological diagnosis. Computed tomography (CT) is the imaging test of choice to confirm the presence and extent of the parenchymal gas. Case ReportA 68-year-old woman was admitted to the medical ward with a one-day history of left lower abdominal pain, vomiting and fever. She had a history of hypertension and type 2 diabetes mellitus, treated with oral anti-diabetic drugs. On examination she presented with fever (39.1°C), her blood pressure was 160/80 mm/Hg and the heart rate was 87 beats per minute. She had left flank pain, accentuated by local palpation. Cardiorespiratory examination was normal. She presented without any focal neurological deficit.Her blood tests showed renal impairment, decompensated diabetes, a high leukocyte count with a neutrophil segment, high inflammatory markers and a very high pro-calcitonin (Table 1). Urinalysis showed the presence of hyaline cylinders. Urine and blood samples were collected for bacterial culture analysis. A plain abdominal radiograph revealed no pathological findings; a renal ultrasound was performed revealing dilatation of the pelvicalyceal system and upper ureter of the left kidney (0.6 cm diameter). The patient was managed with intravenous fluids and insulin to achieve euglycemia. In suspicion of pyelonephritis, empiric intravenous antibiotics in the form of levofloxacin and meropenem were administered. A plain non-contrast CT (NCCT) scan demonstrated the presEmphysematous pyelonephritis: a case report ABSTRACTEmphysematous pyelonephritis is a severe, life-threatening, necrotizing kidney disease. It occurs almost exclusively in patients with diabetes mellitus. The clinical manifestations are those of pyelonephritis such as dysuria, fever, nausea, vomiting and abdominal pain. The diagnosis is radiological. The treatment strategies are controversial. They include medical management only, percutaneous catheter drainage plus medical management, emergency nephrectomy plus medical treatment or percutaneous drainage plus medical management and emergency nephrectomy. We present the case of a 68-year-old woman affected by e...

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“…Emphysematous pyelonephritis (EP) is an acute necrotizing infection complicated by gas formation within the renal parenchyma. 1 Four factors lead to risk for EP: high blood glucose, poor tissue perfusion, the presence of gas forming bacteria, and immunosuppression. E. coli is the pathogen in most cases.…”

Section: Discussionmentioning

confidence: 99%

Emphysematous Pyelonephritis

Chaaban

Siddiqi²

2014

kjm

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A 52-year-old female known to have uncontrolled type 2 diabetes mellitus (hemoglobinated A1c level of 11.2%) and history of recurrent urinary tract infections was admitted with diabetic ketoacidosis and sepsis presumably secondary to a urinary infection. Physical examination was noteworthy for left flank tenderness. Computed tomography of the abdomen and pelvis revealed diffuse air throughout the parenchyma within Gerota's fascia consistent with emphysematous pyelonephritis (see image). The patient was started on broad-spectrum antibiotics and underwent left nephrectomy. Post-operatively, she required pressor agents for septic shock. A urine culture grew ceftriaxone-sensitive Escherichia coli. She was discharged to finish a 14-day course of intravenous antibiotics which she tolerated well with no other complications.

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Emphysematous pyelonephritis: Outcome with conservative management

Cited by 15 publications

References 8 publications

Emphysematous pyelonephritis: Is nephrectomy warranted?

Emphysematous pyelonephritis: Is nephrectomy warranted?

Emphysematous pyelonephritis: a case report

Emphysematous Pyelonephritis

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