Tailored Treatment Approach for Emphysematous Pyelonephritis

Abstract

Objective: We evaluated the clinical presentation, diagnosis and management of patients presenting with emphysematous pyelonephritis (EP). Patients and Methods: The clinical data of 24 EP patients diagnosed between 2000 and 2009 were retrospectively reviewed. The management strategies were discussed according to the severity of condition at presentation. Results: The mean age of the patients was 61.8 years. Diabetes mellitus was detected in 21 (87.5%) of them. Escherichia coli was the predominant pathogen. There were 6 patients (25%) who recovered with antibiotic treatment only (mild). Percutaneous drainage in addition to antimicrobial chemotherapy was necessary in 13 cases (54%) (moderate). The remaining 5 patients (21%) were treated by nephrectomy (severe). Conclusions: EP is a serious infection that can display a fatal progression despite ablative treatment but there are also some cases with mild or moderate severity that can be successfully treated without nephrectomy.

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

“…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.…”

“…The simple explanation is that this gives a combination of high tissue glucose concentrations, impaired tissue perfusion, and the presence of gas-producing organisms, the ideal environment for developing EPN [17]. The high tissue glucose level acts as a substrate for the micro-organisms to produce hydrogen and carbon dioxide by fermenta- [17].…”

“…The simple explanation is that this gives a combination of high tissue glucose concentrations, impaired tissue perfusion, and the presence of gas-producing organisms, the ideal environment for developing EPN [17]. The high tissue glucose level acts as a substrate for the micro-organisms to produce hydrogen and carbon dioxide by fermenta- [17]. In patients with no DM, urinary albumin is thought to substitute for glucose [17], but glucose is a more favourable substrate for the gas-producing organisms, and thus EPN is more prevalent in the patient with DM.…”

“…The high tissue glucose level acts as a substrate for the micro-organisms to produce hydrogen and carbon dioxide by fermenta- [17]. In patients with no DM, urinary albumin is thought to substitute for glucose [17], but glucose is a more favourable substrate for the gas-producing organisms, and thus EPN is more prevalent in the patient with DM.…”

“…However, these were not only based on relatively few patients, but between the studies they also had varying results for the same risk variable. Furthermore, other studies attempted to delineate the management based on the CT findings, but these too were also based on few patients and were not based on robust classifications [3,7,[17][18][19].…”