Successful medical treatment of emphysematous pyelonephritis in chronic hemodialysis

Abstract

Emphysematous pyelonephritis (EPN) is a life-threatening renal infection caused by gas-producing bacteria and fungi. It usually occurs in patients with diabetes and patients with urinary tract obstruction. A combination of systemic antibiotics, percutaneous catheter drainage, or open nephrectomy is typically required to achieve cure. Because of grim prognosis, resorting to interventional methods is frequently inevitable. We report the case of a 77-year-old woman with diabetes and end-stage renal disease on chronic hemodialysis that presented with fever and left flank pain. A bubbly gas pattern inside the left kidney was demonstrated on abdominal computed tomography scan and blood cultures grew Escherichia coli. She was successfully treated solely with systemic antibiotics. This highlights the fact that prompt recognition of imaging findings associated with benign prognosis is essential for a favorable outcome. It allows for an effective management avoiding high-risk interventions, especially in frail patients with multiple comorbidities. Finally, we review all published cases of EPN in chronic dialysis patients.

Emphysematous pyelonephritis and cystitis in a patient with uremia and anuria

“…To date, 20 cases of EPN with ESRD were able to be retrieved on PubMed. [ 11 – 15 ] However, 4 of the 20 patients have to be excluded due to a lack of detailed information. Of the rest 16 patients with 7 males and 9 females, 2 were on peritoneal dialysis and 14 were on hemodialysis.…”

“…Several factors may be involved in the pathogenesis of EPN and EC in this group: growth of bacteria was convenient in hyperglycemic condition; rinse action of urine was reduced while CKD progress to anuria and oliguria; renal blood supply was losing as the eGFR reduced, thus urinary tract is prone to necrosis due to stress or infection; lower immunity of CKD patients, especially when complicated with diabetes. [ 11 , 16 ] Generally speaking, the prognosis of EPN in ESRD patients is optimistic with appropriate treatment according to the data as above.…”

“…This case has 4 features, asymptomatic: no symptoms of urethritis or micturition desire, even when fluid and gas were identified in his urinary bladder from the abdominal CT. The fever was not associated with the infection because it vanished without treatment; younger age: 38 years old was the youngest one in previous literatures; [ 11 ] bilateral EPN: incidence of bilateral EPN was uncommon; intravenous antibiotic only: conservative management resulted in a good outcome.…”

Tubercular empyema a sequalae of emphysematous pyelonephritis with porous diaphragm syndrome and its successful management: A case report

“…Managing empyema secondary to DPS is challenging due to poor debility and septicemia. The most important predisposing factors for EP are DM and UTI [2] . The compromised host-defense mechanism and associated EP leading to peritonitis explain the pathogenesis [3] .…”

“…Emphysematous pyelonephritis (EP) is a life-threatening renal disease requiring early, and immediate therapy, while computed tomography (CT) is the gold standard for early diagnosis [1] , [2] . EP leading to a splenic abscess and further rupturing into the pleural cavity secondary to porous diaphragm syndrome (PDS), resulting in tubercular empyema, is unusual, with no reports to date, and management for PDS remains a challenge.…”