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Chaudhari P, Sawant R, Bordoloi M, Kumar S, Acharya S. Non-albicans Candida Infection as a Rare Cause of Emphysematous Pyelonephritis in an Uncontrolled Diabetic Patient: A Case Report. Cureus 2024; 16:e57036. [PMID: 38681271 PMCID: PMC11046370 DOI: 10.7759/cureus.57036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
The uncommon but dangerous condition known as emphysematous pyelonephritis (EPN) usually affects people with diabetes. This potentially fatal illness is characterized by gas-forming necrosis of the kidneys and surrounding tissues, typically brought on by urinary tract bacteria. Fungal EPN, less prevalent than bacterial EPN, has been reported in a few isolated cases. Cultures of the urine or blood often detect the infection. With an 18% fatality rate, EPN is still a serious illness despite advancements in therapy. High suspicion for EPN is critical in diabetic patients experiencing pyelonephritis. Interestingly, women with uncontrolled diabetes seem to be more susceptible. While Escherichia coli is the usual culprit, rare cases involve Candida species. This case report describes a pathogen that is rarely encountered and causes EPN. A diabetic woman in her sixties without prior hospitalizations presented with a sudden fever and excruciating abdominal pain. The patient also complained of abdominal distension with reduced urine output and breathlessness at rest. Investigations revealed left-sided EPN that was "WAN Type 1." We treated the patient according to culture sensitivity with systemic antifungals, percutaneous nephrostomy (PCN), and ureteral stenting (double J stent or DJ stent). Following successful treatment, the patient recovered and was discharged. This case highlights the importance of considering uncommon causes, even in seemingly typical presentations of EPN. Our case is unique as the patient had an infection with non-albicans Candida with a complication of anuric acute kidney injury and uncontrolled diabetes mellitus.
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Affiliation(s)
| | - Rucha Sawant
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | | | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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Tada K, Shibata R, Nakamura T, Kawaguchi Y, Nakano Y, Ishii H, Ura K, Yamada H, Maekawa S, Ito K, Masutani K. Severe disseminated infection by hypermucoviscous Klebsiella pneumoniae successfully treated by intensive therapy with continuous hemodiafiltration using AN69ST: A case report and review of the literature. J Infect Chemother 2023; 29:1075-1080. [PMID: 37451619 DOI: 10.1016/j.jiac.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/09/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Klebsiella pneumoniae (Kpn) is one of the most common gram-negative bacilli causing lung, urinary tract, and biliary tract infections. However, as a distinct entity from classic Kpn, hypervirulent Kpn causing liver abscess, endophthalmitis, and lung abscess with poor prognoses has been reported mainly in East and Southeast Asia since the mid-1980s. Although the definition of hypervirulent Kpn is unclear, the hypermucoviscosity of Kpn is considered an important feature of hypervirulence. We present a case of emphysematous pyelonephritis accompanied by septic shock and acute kidney injury caused by hypermucoviscous Kpn infection that was successfully treated by intensive treatment. A 70-year-old woman with type 2 diabetes mellitus was diagnosed with emphysematous pyelonephritis, and string test-positive Kpn was detected in blood and urine cultures and percutaneous catheter drainage fluid from the renal pelvis. The patient was treated with intensive therapies including antibiotics, ventilator management, and continuous hemodiafiltration (CHDF) using AN69ST, which can absorb cytokines. During the course of treatment, the infection was complicated by pyogenic spondylitis, which was cured by antimicrobial therapy, and the patient was transferred to another hospital for rehabilitation on day 119 after admission. Hypermucoviscous Kpn infection often has a severe course, and it is important to initiate multidisciplinary treatment at an early stage, including rifampicin, which is expected to inhibit the viscosity of hypermucoviscous Kpn. In the current case, immediate CHDF using AN69ST was also considered a life-saving treatment because it improved both volume overload and neutrophil-activated hypercytokinemia.
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Affiliation(s)
- Kazuhiro Tada
- Department of Nephrology, Saiseikai Futsukaichi Hospital, Fukuoka, Japan.
| | - Ryoko Shibata
- Department of Nephrology, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Tsubasa Nakamura
- Department of Nephrology, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | | | - Yuki Nakano
- Department of Pharmacy, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Hidehiro Ishii
- Department of Diabetology, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Kazuya Ura
- Department of General Internal Medicine, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Hiroyoshi Yamada
- Department of Respiratory Medicine, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Shinichi Maekawa
- Department of General Thoracic Surgery, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Kenji Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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A case of emphysematous pyelonephritis caused by the hypermucoviscosity phenotype of Klebsiella pneumoniae. Urol Case Rep 2022; 46:102290. [DOI: 10.1016/j.eucr.2022.102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
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Storey B, Nalavenkata S, Whitcher S, Blatt A. Emphysematous Pyelonephritis: A Twelve-year Review in A Regional Centre. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2022.2021.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Prevalence and Risk Factors of Mortality in Emphysematous Pyelonephritis Patients: A Meta-Analysis. World J Surg 2022; 46:2377-2388. [PMID: 35802159 DOI: 10.1007/s00268-022-06647-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Emphysematous pyelonephritis (EP) is a severe necrotizing infection of the renal parenchyma which is associated with significant case mortality. We sought to identify the incidence and predictive risk factors associated with EP mortality. METHODS Two electronic databases, PubMed and Web of Science, were searched from their inception until June 06, 2021 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. RESULTS Of the 1080 retrieved abstracts, 79 underwent full-text review and 45 studies were included in the final analysis, comprising a total cohort of 1303 patients and 177 mortalities. The pooled prevalence of mortality among the patients with EP disease was 13%. Our analysis found a significantly decreasing trend in mortality rates, an increasing trend in minimally invasive intervention and decreasing trends in emergency nephrectomy in the EP studies from 1985 to 2020. Significant risk factors that were associated with a negative impact on survival of EP patients included sepsis (OR = 15.99), shock (OR = 15.57), disturbance of consciousness (OR = 12.11), thrombocytopenia (OR 7.85), acute renal failure (OR = 5.41), Wan classification I (OR = 4.57), emergency nephrectomy (OR = 3.73), Huang-Tseng classification III-IV (OR = 2.4) and medical management alone (OR = 2.04). Female sex (OR = 0.52) and minimally invasive intervention (OR = 0.47) (percutaneous nephrostomy or ureteral stent placement) were associated with decreased mortality rates. CONCLUSIONS Our study results demonstrated several significant risk factors that could help guide treatment to reduce the mortality risk of EP patients. Clinically, early treatment with a combination of minimally invasive intervention and appropriate medical management may be protective for reducing mortality risk in EP patients.
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Desai R, Batura D. A systematic review and meta-analysis of risk factors and treatment choices in emphysematous pyelonephritis. Int Urol Nephrol 2022; 54:717-736. [PMID: 35103928 DOI: 10.1007/s11255-022-03131-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/25/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Emphysematous pyelonephritis (EPN) is an acute, severe necrotising infection of the kidney. There has been a shift from early nephrectomy to conservative methods. We conducted a meta-analysis to assess the impact of risk factors and treatment choices on outcomes in EPN. METHODS We conducted a database search of all studies in English, reporting more than 12 patients of EPN from 1980 to 2020. We compiled the demographics, clinical presentations, risk factors, critical diagnostic results, treatment modalities and outcomes, including mortality. RESULTS We identified 37 observational studies, 32 retrospective and 5 prospective. The studies reported on 1146 patients, of which 790(68.9%) were female, and 946 (82.5%) were diabetic. In addition, 184 (16.1%) patients had stones, and 235 (20.5%) had obstructive uropathy. Fever and flank pain were the most frequent symptoms. The most common clinical features were pyuria, fever, flank tenderness, and tachycardia. E. coli, Klebsiella pneumoniae and Proteus were the most frequent organisms isolated. X-ray KUB and ultrasound were used as initial diagnostic modalities, but CT scan was the usual diagnostic and confirmatory investigation. Confusion, shock, thrombocytopenia, sepsis, emergency nephrectomy and hyponatremia were significantly associated with mortality. In particular, confusion and hyponatremia were associated with a sevenfold increase in mortality risk. There was no evidence that diabetes, stones, obstructive uropathy, AKI or proteinuria was associated with higher mortality. Nevertheless, 143 of the total 1146 patients died (12.5%). While 26% of the patients who had upfront emergency nephrectomy died, only 9.7% and 10% of patients with medical management and medical management plus minimally invasive treatments died. However, patients that failed medical and minimally invasive treatments and needed salvage emergency nephrectomy had a mortality of upwards of 27%. CONCLUSION The risk factors for mortality in emphysematous pyelonephritis are shock, thrombocytopenia, confusion, hyponatremia and emergency nephrectomy. Conservative and minimally invasive treatment should be the initial management strategy for emphysematous pyelonephritis as they carry lesser mortality risks. The presence of risk factors may help predict the subset of patients who need aggressive treatment and minimally invasive treatment modalities or early nephrectomy.
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Affiliation(s)
- Rajeev Desai
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Deepak Batura
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
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D'Amico M, Izes J, Das A. Case report: Bilateral emphysematous pyelonephritis with pneumatosis intestinalis. Urol Case Rep 2021; 40:101895. [PMID: 34712588 PMCID: PMC8528675 DOI: 10.1016/j.eucr.2021.101895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022] Open
Abstract
Emphysematous pyelonephritis is a severe and rare gas producing infection in the renal parenchyma or collecting system. Diabetes mellitus is an established risk factor. Treatment options include antibiotics, minimally invasive management such as percutaneous drainage, or nephrectomy. This case report describes a 40-year-old female with newly diagnosed diabetes and cirrhosis who presented with left sided emphysematous pyelonephritis. After initial management with intravenous antibiotics and drainage of the collecting system, this patient's clinical condition worsened, and subsequent repeat imaging revealed bilateral emphysematous pyelonephritis as well as pneumatosis intestinalis.
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Affiliation(s)
- Maria D'Amico
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Joseph Izes
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Akhil Das
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
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Poggiali E, Tansini F, Christodoulakis K, Giovini M, Magnacavallo A, Vercelli A. A case of hematuria and vomiting in the emergency room: Never forget the emphysematous pyelonephritis. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We describe the case of a 68-year-old man with a known history of hypertension and diabetes mellitus presented to our Emergency Department, complaining of hematuria and vomiting in the last 12 hours, stypsis and urinary incontinence in the last week, and worsening hyporexia in the last 6 months. Bedside ultrasound documented a slight right pleural effusion with B lines in the middle and basal right field, gastrectasis, dilated fluid-filled bowel loops, potential signs of gas in the upper right quadrant, grade 3 bilateral hydronephrosis, and bladder globe. Abdominal CT scan confirmed the bilateral hydroureteronephrosis and showed the right kidney with Emphysematous Pyelonephritis (EPN) with extension into the perinephric and muscular planes for 24 cm, and initial EPN in the left kidney. A RT-PCR nasopharyngeal swab for SARS CoV-2 was negative. A diagnosis of ileum paretic, acute renal failure and urosepsis due to EPN was made.
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Liston K, Manecksha RP, Woods CP. Hyperglycaemic crisis secondary to emphysematous pyelonephritis. BMJ Case Rep 2021; 14:e242617. [PMID: 34380678 PMCID: PMC8359521 DOI: 10.1136/bcr-2021-242617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old woman presented to the emergency department acutely unwell. Initial investigations revealed hyperglycaemia, ketosis and an acute kidney injury precipitated by urosepsis. She was found to have a new diagnosis of diabetes mellitus (type 2) with a glycated haemoglobin (HbA1c) of 156 mmol/mol. CT imaging of the abdomen and pelvis revealed unilateral emphysematous pyelonephritis (EPN), radiologically classified as stage 3 severity with gas extending beyond the renal collecting system. Escherichia coli was grown on blood and urine cultures. This was sensitive to second-generation cephalosporin cefuroxime. The patient was managed with fluid resuscitation, intravenous antibiotics and renal system decompression with urinary catheter insertion. She was commenced on an intravenous insulin infusion for hyperglycaemic crisis. This case illustrates a rare presentation of hyperglycaemic crisis precipitated by EPN in a patient without a previously known diagnosis of diabetes, successfully treated with medical management alone. Close clinical and radiological follow-up was arranged to monitor the need for future nephrectomy.
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Affiliation(s)
- Katie Liston
- Endocrinology, HSE Library East, Naas, Ireland
- Endocrinology, Naas General Hospital, Naas, Kildare, Ireland
- Tallaght University Hospital, Dublin, Dublin, Ireland
| | - Rustom P Manecksha
- Urology, Tallaght University Hospital, Dublin, Dublin, Ireland
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Conor P Woods
- Endocrinology, Naas General Hospital, Naas, Kildare, Ireland
- Tallaght University Hospital, Dublin, Dublin, Ireland
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Rahim MA, Ananna MA, Iqbal S, Uddin KN, Latif ZA. Emphysematous pyelonephritis: experience at a tertiary care hospital in Bangladesh. J R Coll Physicians Edinb 2021; 51:19-23. [PMID: 33877129 DOI: 10.4997/jrcpe.2021.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN. METHODS This retrospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between 2014 and 2020. RESULTS We followed 20 patients (mean age 49.4 years; females 70%). Risk factors for EPN were diabetes mellitus (in 100%) and renal stones (in 10%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury (AKI, 70%; mostly stage 1, 78.6%), hyponatraemia (55%) and bacteraemia (15%). Escherichia coli was the most common (60%) urinary isolate. Most patients (80%) had class 2 EPN, with 15% class 3B and 5% class 3A. Besides medical management, four (20%) required surgery (nephrectomy in 3). Nephrectomised patients had a higher radiological class (p = 0.032) and incidence of AKI (p = 0.034). No deaths occurred. CONCLUSION EPN occurred predominantly in female diabetic patients, who presented with fever, loin pain, vomiting and dysuria. Two-thirds of patients had AKI and one-fifth required surgery, and there were no deaths.
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Affiliation(s)
- Muhammad Abdur Rahim
- Department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh,
| | | | - Sarwar Iqbal
- Department of Nephrology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Khwaja Nazim Uddin
- Department of Internal Medicine, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Zafar Ahmed Latif
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
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Schutz EA, Zabott AP, Boaretto RBB, Toyama G, Morais CFD, Moroni JG, Oliveira CSD. Emphysematous pyelonephritis caused by C. glabrata. ACTA ACUST UNITED AC 2021; 44:447-451. [PMID: 33760910 PMCID: PMC9518622 DOI: 10.1590/2175-8239-jbn-2020-0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
Emphysematous pyelonephritis (EPN) is a rare acute necrotizing infection of the
kidney and surrounding tissues, with gas in the renal parenchyma, collecting
system or perirenal tissue. The bacterial etiology predominates; mainly
Gram-negative bacilli; Candida spp. and C.
albicans are rarely described. We describe a case of EPN caused by
C. glabrata, sensitive to fluconazole in a young,
hypertensive woman with undiagnosed diabetes mellitus (DM),
with renal dysfunction upon admission; her abdominal CT scan found a volumetric
increase in the left kidney, signs of gas collections and perirenal blurring.
Despite the antimicrobial therapy instituted, due to clinical refractoriness, a
double J catheter and subsequent total nephrectomy were indicated, with good
postoperative evolution. Her uroculture showed C. glabrata
sensitive to fluconazole, and the pathology study showed tubular atrophy and
intense interstitial inflammatory infiltrate. Despite the serious, potentially
fatal condition, we could control the infection and the patient recovered fully.
Poor DM management is an important triggering factor, and it is of great
relevance to identify the EPN through imaging exams due to the peculiarities of
its clinical and potentially surgical management
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Affiliation(s)
- Eduardo Augusto Schutz
- Universidade Estadual do Oeste do Paraná (Unioeste), Centro de Ciências Médicas e Farmacêuticas (CCMF), Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brasil
| | - Ana Paula Zabott
- Universidade Estadual do Oeste do Paraná (Unioeste), Centro de Ciências Médicas e Farmacêuticas (CCMF), Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brasil
| | - Rubia Bethania Biela Boaretto
- Universidade Estadual do Oeste do Paraná (Unioeste), Centro de Ciências Médicas e Farmacêuticas (CCMF), Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brasil
| | - Gisele Toyama
- Universidade Estadual do Oeste do Paraná (Unioeste), Centro de Ciências Médicas e Farmacêuticas (CCMF), Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brasil
| | - Carlos Floriano de Morais
- Universidade Estadual do Oeste do Paraná (Unioeste), Centro de Ciências Médicas e Farmacêuticas (CCMF), Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brasil
| | - Juliana Gerhardt Moroni
- Universidade Estadual do Oeste do Paraná (Unioeste), Centro de Ciências Médicas e Farmacêuticas (CCMF), Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brasil
| | - Carla Sakuma de Oliveira
- Universidade Estadual do Oeste do Paraná (Unioeste), Centro de Ciências Médicas e Farmacêuticas (CCMF), Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brasil
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Pneumorachis and spondylodiscitis caused by emphysematous pyelonephritis. Int Urol Nephrol 2020; 53:91-92. [PMID: 32778996 DOI: 10.1007/s11255-020-02598-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/31/2020] [Indexed: 12/23/2022]
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Song Y, Shen X. Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review. BMC Urol 2020; 20:6. [PMID: 31996190 PMCID: PMC6990560 DOI: 10.1186/s12894-020-0575-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background The management of emphysematous pyelonephritis (EPN) includes conservative medical treatment, percutaneous drainage, and surgical resection of the involved kidney. EPN with diabetic ketoacidosis(DKA) is very rare, in which the clinical management of refusing surgical drainage is inexperienced. Case presentation A 34-year-old woman presented with abdominal pain, chills, fever, nausea, vomiting, chest tightness, and shortness of breath. Blood test results were consistent with diabetic ketoacidosis. Urinary computed tomography scan showed multiple stones in the right kidney and lower ureter, with right hydronephrosis. Blood culture demonstrated Escherichia coli bacteremia, and EPN was diagnosed. Considering the need for a second percutaneous nephrolithotomy, the patient refused percutaneous drainage. After continuous intravenous infusion of small doses of insulin and antibiotic treatment, the ketoacidosis resolved. The patient’s temperature returned to normal and abdominal pain was alleviated, and liver and kidney functions were also back to normal. After hospital discharge, the patient underwent two percutaneous nephrolithotomy in the department of urology. Conclusions EPN with diabetic ketoacidosis should be diagnosed as soon as possible. For patients with Class 1 and Class 2 EPN with diabetic ketoacidosis and urinary tract obstruction, if surgical drainage is refused, it is particularly important to rapidly correct diabetic ketoacidosis and intravenous use of sensitive antibiotics, so as to create conditions for follow-up percutaneous nephrolithotomy.
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Affiliation(s)
- Yuanhao Song
- Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, 361004, Fujian, China
| | - Xingping Shen
- Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, 361004, Fujian, China.
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Wu CJ, Lee WJ, Chau SW, Tsai TY, Lee YK. Man With Left Flank Pain. Ann Emerg Med 2020; 75:e9-e10. [DOI: 10.1016/j.annemergmed.2019.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Indexed: 10/25/2022]
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Deoraj S, Zakharious F, Nasim A, Missouris C. Emphysematous pyelonephritis: outcomes of conservative management and literature review. BMJ Case Rep 2018; 2018:bcr-2018-225931. [PMID: 30209146 DOI: 10.1136/bcr-2018-225931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is a rare, necrotising infection of the renal parenchyma, predominantly associated with Escherichia coli infection and unless promptly recognised and dealt with, it carries a poor prognosis. The current treatment is one of antimicrobial therapies together with nephrectomy in a majority of patients. We report an elderly man with multiple comorbidities with a diagnosis of EPN whose condition improved with antimicrobial and supportive therapy, and no surgical intervention was required.
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Affiliation(s)
- Stuart Deoraj
- Department of Cardiology, Frimley Health Foundation Trust, Slough, Berkshire, UK
| | - Fady Zakharious
- Department of Cardiology, Frimley Health Foundation Trust, Slough, Berkshire, UK
| | - Ashraf Nasim
- Department of Cardiology, Frimley Health Foundation Trust, Slough, Berkshire, UK
| | - Constantinos Missouris
- Department of Cardiology, Frimley Health Foundation Trust, Slough, Berkshire, UK.,Medical School, University of Cyprus, Nicosia, Cyprus
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Li S, Wang J, Hu J, He L, Wang C. Emphysematous pyelonephritis and cystitis: A case report and literature review. J Int Med Res 2018; 46:2954-2960. [PMID: 29916283 PMCID: PMC6124253 DOI: 10.1177/0300060518770341] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
This present case report describes a 64-year-old female patient with type 2 diabetes mellitus who also had emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC). Computed tomography revealed well defined emphysematous pyelonephritis and cystitis. Broad-spectrum antibiotic and percutaneous drainage of the right kidney were used as part of a conservative management regimen. The patient achieved clinical recovery and was discharged 12 days after admission. Furthermore, 13 other cases of EPC and EC that were reported between 1962 and 2017 were reviewed and discussed. The overall mortality was 15.4% (two of 13 patients), compared with 25% for EPN alone or 7.4% for EC alone as reported in the literature. The primary pathogen identified in the 13 patients was Escherichia coli (53.8%). All 13 patients were treated with antibiotics.
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Affiliation(s)
- Shengxian Li
- 1 Department of Urology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jixue Wang
- 1 Department of Urology, First Hospital of Jilin University, Changchun, Jilin Province, China.,2 Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin Province, China
| | - Jinghai Hu
- 1 Department of Urology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Liang He
- 1 Department of Urology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Chunxi Wang
- 1 Department of Urology, First Hospital of Jilin University, Changchun, Jilin Province, China
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