Emphysematous Pyelonephritis

Michaeli, Joseph; Mogle, P; Perlberg, S.; Heiman, S.; Caine, Marco

doi:10.1016/s0022-5347(17)50309-2

Cited by 298 publications

(246 citation statements)

References 35 publications

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“…EPN due to Pseudomonas, Enterobacter, Candida and Citrobacter freundii have also been reported. [7][8][9] High levels of glucose in the vicinity of the renal tissue and impaired tissue perfusion serve as predisposing factors. 10,11 These organisms ferment sugars within the urine, thereby, producing gases like nitrogen, oxygen, hydrogen and carbon dioxide.…”

Section: Discussionmentioning

confidence: 99%

Emphysematous pyelonephritis presenting in acute respiratory distress syndrome: a case report

et al. 2017

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Emphysematous pyelonephritis is a life-threatening infection of the kidneys characterized by acute necrosis with associated gas formation involving the renal parenchyma and perinephric tissues. It is a rare condition and occurs mostly in diabetic females, carrying a high mortality rate. The management involves antibiotics and surgical interventions. This is a case of an elderly lady, diabetic, who had fever and burning micturition and was initially treated with oral antibiotics. She later presented with fever, dyspnoea and dysuria, and was diagnosed to have emphysematous pyelonephritis with acute respiratory distress syndrome. She was successfully managed with broad spectrum antibiotics and percutaneous nephrostomy. As emphysematous pyelonephritis requires both medical and surgical interventions, this case, therefore, highlights the importance of its early detection, as it can be life-saving.

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Section: Discussionmentioning

confidence: 99%

Emphysematous pyelonephritis presenting in acute respiratory distress syndrome: a case report

et al. 2017

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“…Coli (50%-70%), followed by Klebsiella, Enterobacter, Proteus and Pseudomonas species. [2] Infrequently, fungi like Candida, Cryptococcus and Aspergillus can cause EPN, and polymicrobial infection is seen in 14%-19% of cases. [2,4] Diagnosis of EPN is based on radiological scans.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Infrequently, fungi like Candida, Cryptococcus and Aspergillus can cause EPN, and polymicrobial infection is seen in 14%-19% of cases. [2,4] Diagnosis of EPN is based on radiological scans. Abdominal ultrasonography and plain radiograph are accurate in only 69% and 65% of cases respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Reported mortality with this standard approach was high at 40%-50%. [2] However, in recent years, there has been a shift in treatment practices with an increasing number of patients being treated with a less invasive approach of percutaneous drainage. Despite this, when faced with a patient, the clinical decision with respect to surgical versus non-surgical management and when to intervene with a nephrectomy, can be a difficult one to make.…”

Section: Introductionmentioning

confidence: 99%

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Emphydematous pyelonephritis - Treat the patient, not the scan

Chia

Tiong

Chien

2015

CSS

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Background: Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma. Until the late 1960s, these patients were treated with nephrectomies as EPN is associated with a high rate of mortality. It is a diagnosis based on computed tomography (CT) scan of the patient and based on the results, can be classified according to the severity of the disease. In our case report, we present a patient with seemingly extensive EPN on CT scan who was treated successfully with intravenous antibiotics (IV) and percutaneous drainage. Methods: Together with current literature, our case study adds to increasing evidence which supports how carefully selected patients can be treated with the above modalities.Results: We present a 75-year-old diabetic Indian gentleman who came to us with right iliac fossa pain and was noted to have a positive right renal punch. CT scan revealed extensive gas in the right kidney. Considering that he was clinically stable amongst other factors, he was started on appropriate IV antibiotics and underwent a percutaneous nephrostomy tube insertion. Subsequent follow-up scans showed resolution of the EPN. Conclusions: EPN is a severe, necrotizing infection of the kidneys associated with high mortality rates. As such, physicians need to have a high index of suspicion in patients who are at risk. There is increasing evidence to show that patients with early EPN can and should be treated with appropriate IV antibiotics and percutaneous drainage procedures. We hope that this will help to increase awareness of the possible treatment modalities of this potentially life-threatening disease.

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“…11 More than 90% of the patients are diabetic and it is seen 6 times more frequently in women than men. 4 Females are more likely to suffer from EPN, with only one exception: males undergoing renal transplantation are more likely to suffer.…”

Section: Uruc Et Almentioning

confidence: 99%

Emphysematous pyelonephritis: Our experience in managing these cases

Uruç

Yüksel

Şahin

et al. 2015

CUAJ

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Introduction: Emphysematous pyelonephritis (EPN) is a rare acute necrotising infection of renal parenchyma. We discuss clinical details and treatment strategies of 8 patients with EPN followed at our clinic. Methods: We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 8 patients with EPN followed at our urology clinic between 2012 and 2015. Results: The mean patient age (female: 5; male: 3) was 62 (range: 51-82) years. Based on computed tomographic findings, EPN was classified as class 1 (n = 3), class 2 (n = 3) and class 3a (n = 2). All patients had fever, flank pain, nausea, and vomiting. Five patients had type 2 diabetes mellitus and 3 diabetic patients also had renal stones. Escherichia coli (n = 6), Klebsiella species (n = 1), and Proteus species (n = 1) were grown in urine cultures. All patients had unilateral involvement. Increased white blood cell counts, sedimentation rate, and C-reactive protein levels were detected in all cases. In addition to medical treatment, 2 patients underwent a nephrostomy catheter placement and another 2 patients underwent nephrectomy upon deterioration of her general health state. After achieving clinical stabilization with medical treatment, 1 patient underwent endoscopic ureteral stone treatment. The remaining 3 cases were treated only with antibiotherapy. All patients were discharged with clinical cure. Conclusion: Mortality rates of EPN are gradually decreasing. Preservation of renal reserve is possible due to early diagnosis, appropriate antibiotherapy, and drainage.

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Emphysematous Pyelonephritis

Cited by 298 publications

References 35 publications

Emphysematous pyelonephritis presenting in acute respiratory distress syndrome: a case report

Emphysematous pyelonephritis presenting in acute respiratory distress syndrome: a case report

Emphydematous pyelonephritis - Treat the patient, not the scan

Emphysematous pyelonephritis: Our experience in managing these cases

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