Emphysematous pyelonephritis: the impact of urolithiasis on disease severity

Abstract

BackgroundEmphysematous pyelonephritis is a severe infection of the kidney associated with formation of gas in the renal parenchyma and/or collecting system. The purpose of this study was to evaluate outcomes of patients with emphysematous pyelonephritis in a contemporary cohort and to evaluate the impact of urolithiasis on disease severity.MethodsA search of all imaging reports at University of California San Francisco (UCSF) for the term “emphysematous pyelonephritis” was undertaken from 2003–2014. Patients were included if there was clinical evidence of infection, no recent urologic instrumentation, and computerized tomography (CT) demonstrating gas in the renal parenchyma or collecting system. Clinical and laboratory variables were obtained from medical records.ResultsA total of 14 cases were identified. The majority of patients (57%) had gas confined to the collecting system. Three patients (21%) had gas in the renal parenchyma and 3 patients (21%) had gas extending into perirenal tissues. A total of 8 patients (57%) had concomitant urolithiasis. Seven patients (50%) were managed with antibiotic therapy alone while 6 patients (43%) required percutaneous drainage. No patients required immediate nephrectomy. There were no deaths. Patients with urolithiasis had less severe emphysematous pyelonephritis than patients without urolithiasis (P<0.05).ConclusionsThe majority of patients in this study had gas contained within the collecting system and were treated successfully with antibiotics alone. Percutaneous drainage was successfully utilized in patients with more advanced disease. No patients required emergent nephrectomy. Emphysematous pyelonephritis in patients with urolithiasis was less severe than in patients without urolithiasis.

Emphysematous Pyelonephritis Complicated With Hyperglycemic Hyperosmolar State and Sepsis: A Case Report and Literature Review

“…The current treatment strategies include medical management (MM) alone, MM plus percutaneous catheter drainage (PCD), MM plus PCD plus double J stents, MM plus nephrectomy, and MM plus PCD plus emergency nephrectomy. These treatment strategies have shown lower mortality rates compared to the 1980s approach [ 2 , 7 , 17 , 18 ]. Over the last three decades, the treatment approach has favored kidney sparing strategies and the use of nephrectomy only as salvage therapy; however, multiple predictive factors for mortality have been identified, which can orient the medical team on which treatment strategy should be followed, expecting better outcomes.…”

Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review

“…Escherichia coli was still the most common pathogen; 4. older age, high bodymass index, impaired renal function, thrombocytopenia, sensory changes, and shock were associated with a poor prognosis; and 5. treatment mainly consisted of rapid hydration, maintenance of electrolyte balance, use of systemic antibiotics, strict control of blood glucose, effective urine drainage, and nephrectomy if necessary [1]. Sanford et al have shown that mild EPN was treatable by conservative management that included infectious agent-susceptible antibiotics [24]. However, patients with severe infections required percutaneous renal puncture drainage and/or double-J stenting [24].…”

“…Sanford et al have shown that mild EPN was treatable by conservative management that included infectious agent-susceptible antibiotics [24]. However, patients with severe infections required percutaneous renal puncture drainage and/or double-J stenting [24].…”

Triboelectric Nanogenerators for Therapeutic Electrical Stimulation

“…It has been shown that through pelvic nerve ES, certain muscles controlling bladder function can be activated, thus enabling researchers to control bladder function. [ 282,283 ] Currently, the main approach to treating bladder dysfunction is utilizing catheters. However, this approach has many shortcomings including the obvious downside that the individual must undergo frequent catheter changes.…”