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Pishdad R, Auwaerter PG, Kalyani RR. Diabetes, SGLT-2 Inhibitors, and Urinary Tract Infection: a Review. Curr Diab Rep 2024; 24:108-117. [PMID: 38427314 DOI: 10.1007/s11892-024-01537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to focus on epidemiology, pathogenesis, risk factors, management, and complications of UTI in people with diabetes as well as reviewing the association of SGLT-2 inhibitors with genitourinary infections. RECENT FINDINGS Individuals diagnosed with T2DM are more prone to experiencing UTIs and recurrent UTIs compared to individuals without T2DM. T2DM is associated with an increased risk of any genitourinary infections (GUI), urinary tract infections (UTIs), and genital infections (GIs) across all age categories. SGLT2 inhibitors are a relatively new class of anti-hyperglycemic agents, and studies suggest that they are associated with an increased risk of genitourinary infections. The management of diabetes and lifestyle modifications with a patient-centric approach are the most recognized methods for preventing critical long-term complications including genitourinary manifestations of diabetes. The available data regarding the association of SGLT-2 inhibitors with genitourinary infections is more comprehensive compared to that with UTIs. Further research is needed to better understand the mechanisms underlining the association between SGLT-2 inhibitors and genital infections and UTIs.
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Affiliation(s)
- Reza Pishdad
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Endocrinology, Diabetes, and Metabolism, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Paul G Auwaerter
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Chippa V, Chenna S, Gujarathi R. Emphysematous Pyelonephritis Involving Native Kidneys and a Transplanted Kidney. Cureus 2022; 14:e29024. [PMID: 36237790 PMCID: PMC9552574 DOI: 10.7759/cureus.29024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/18/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is an acute severe necrotizing form of UTI, with air collection in the renal parenchyma, collecting system, and surrounding tissues. Most common causative organisms are Escherichia coli and Klebsiella. Here we present a 71-year-old Caucasian male with multiple medical problems who was transferred to our ER from a long-term acute care hospital (LTACH) for hematuria, UTI, and septic shock. He is a recipient of a deceased donor renal transplant and was receiving IV amphotericin B for recent cryptococcal meningitis. CT abdomen showed bilateral EPN, including the transplanted kidney. He received aggressive fluid resuscitation, vasopressors, and IV antibiotics and got admitted to the ICU. Unfortunately, his clinical course worsened and required ventilatory support, and his family opted for comfort care because of the high mortality rate. The emphasis of this case report is to investigate immunocompromised patients presenting with UTIs for EPN.
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Jiya FB, Ibitoye PK, Jiya NM, Amodu-Sanni M, Mohammed Y, Aquib DM, Coker LK. Emphysematous pyelonephritis in an infant from Sokoto, north-western Nigeria. Afr J Lab Med 2021; 10:1181. [PMID: 34007815 PMCID: PMC8111630 DOI: 10.4102/ajlm.v10i1.1181] [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: 01/27/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Emphysematous pyelonephritis is a life-threatening necrotising bacterial infection of the kidneys. It is rare among children and can be fatal if not promptly identified and treated. Case presentation A 7-month-old male infant presented to the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, on 12 November 2019 with a 5-day history of fever and vomiting, and a 3-day history of a progressively enlarging, left-side abdominal mass. There was associated excessive crying on micturition, refusal to feed and weight loss. He looked ill and was in respiratory distress, irritable, febrile (38.8 °C), moderately dehydrated and pale. His weight and length were 5.5 kg and 64 cm. He had a tender, firm and ballotable abdominal mass on the left flank measuring 8 cm × 10 cm. His pulse rate was 140 beats/min, blood pressure 60/40 millimetres of mercury and respiratory rate was 65 cycles/min. He had widespread coarse crepitations and normal heart sounds on chest auscultation. Management and outcome An initial diagnosis of sepsis was made. Other considerations were nephroblastoma and neuroblastoma. Ceftriaxone and blood transfusion were commenced with subsequent administration of intravenous fluids. Further radiologic investigations revealed emphysematous pyelonephritis. The patient had percutaneous drainage and extended spectrum β-lactamase-producing Escherichia coli (sensitive to meropenem) which was isolated from the aspirate culture after 48 h of incubation. Meropenem could not be commenced because of non-availability and high cost. The patient subsequently deteriorated and died from septic shock. Conclusion Emphysematous pyelonephritis has a fulminant course when not diagnosed promptly and treated adequately.
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Affiliation(s)
- Fatima B Jiya
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Paul K Ibitoye
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Nma M Jiya
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Maryam Amodu-Sanni
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Yahaya Mohammed
- Department of Medical Microbiology and Parasitology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Dada M Aquib
- Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Lukman K Coker
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Wan Hanafi HH, Mustaffa N, Lee YY, Mohd Nawi SN. Emphysematous pyelonephritis: A rare cause of sepsis in hepatocellular carcinoma. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/2010105821992805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The association between emphysematous pyelonephritis (EPN) and diabetes mellitus is well known. EPN as the cause of sepsis in hepatocellular carcinoma (HCC) is rare and unreported. We report a case of EPN in a non-diabetic HCC patient, in which the clinical features of decompensated chronic liver disease masked the more sinister urological emergency to a certain degree. A computed tomography scan of the abdomen revealed a mixture of gas and fluid in the left retrorenal space, in keeping with left EPN. Nevertheless, the course of clinical deterioration was rather rapid that any surgical intervention was not feasible.
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Affiliation(s)
- Hany Haqimi Wan Hanafi
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nazri Mustaffa
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Yeong Yeh Lee
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Siti Nurbaya Mohd Nawi
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
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Cases-Corona C, Shabaka A, Gonzalez-Lopez A, Martin-Segarra O, Moreno de la Higuera MA, Lucena R, Fernandez-Juarez G. Fulminant Emphysematous Pyelonephritis by Candida glabrata in a Kidney Allograft. Nephron Clin Pract 2020; 144:304-309. [DOI: 10.1159/000507259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/14/2020] [Indexed: 12/31/2022] Open
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Urological infections in the developing world: an increasing problem in developed countries. World J Urol 2020; 38:2681-2691. [PMID: 32108257 DOI: 10.1007/s00345-020-03120-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/03/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Infectious diseases that often follow geographical distribution patterns are increasingly crossing such boundaries, aided by human travel and commerce. These pose a new challenge to physicians who are required to diagnose previously unseen conditions and address drug-resistant organisms. We review some such common infections. METHODS A literature review was performed for six common urological infections and a narrative review based on recent publications on these infections was compiled. RESULTS In Urology, some infections that are now crossing geographical boundaries include Brucellosis, Schistosomiasis, Tuberculosis, Filariasis, Hydatidosis and emphysematous pyelonephritis. Brucellosis, a zoonotic infection, is common in the Mediterranean areas, Asia, South America and Africa. Infection can involve all parts of the genitourinary tract. Schistosomiasis, a parasitic disease, is particularly common in Sub-Saharan Africa and may have bacterial superinfection. Voiding symptoms are common and bladder carcinoma may develop. Tuberculosis affects almost every organ in the body and in the male genital system, often presents with abscesses, nodules, ulcers and infertility that is difficult to manage. Filariasis is caused by two species of worms and is transmitted through a bite from a mosquito carrying larvae of the worm. It causes lymphatic obstruction leading to scrotal edema, hydrocoele to elephantiasis of scrotum. Emphysematous pyelonephritis is a life-threatening suppurative necrotizing infection of the renal parenchyma. While not being geographically limited, it is more common in developing areas with poor health care access. Genitourinary hydatidosis is a rare disease that is associated mainly with renal involvement in the genitourinary tract. Large cysts with destruction of renal parenchyma may be found. CONCLUSIONS Although uncommon, these urological infections are associated with significant morbidity and mortality and awareness in all healthcare settings is now an essential requirement.
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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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Lotfali E, Abolghasemi S, Gatmirimotahhari FS, Alizadeh M, Arab-Mazar Z. Complicated bilateral fungal emphysematous pyelonephritis in a 55-year-old diabetic female: A case report and review of literature. Curr Med Mycol 2018; 4:32-35. [PMID: 30324155 PMCID: PMC6181061 DOI: 10.18502/cmm.4.2.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background and Purpose: Emphysematous pyelonephritis (EPN) is a rare and serious disease causing acute renal failure. Diabetes is a major risk factor for this infection. Case report: Herein, we present the case of a 55-year-old female patient with diabetes and EPN caused by Candida albicans. The infection was complicated with endophthalmitis and endocarditis. The results of antifungal susceptibility analysis showed that C. albicans was resistant to fluconazole and susceptible to amphotericin-B and itraconazole. Infection could be controlled by amphotericin-B followed by itraconazole therapy, and the patient was discharged in good condition while receiving antifungal therapy. Conclusion: Complicated pyelonephritis with unusual microorganisms should be considered in patients with diabetes and urinary symptoms.
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Affiliation(s)
- Ensieh Lotfali
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Abolghasemi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medial Sciences, Tehran, Iran
| | | | - Mohammad Alizadeh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medial Sciences, Tehran, Iran
| | - Zahra Arab-Mazar
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medial Sciences, Tehran, Iran
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Karthikeyan VS, Manohar CMS, Mallya A, Keshavamurthy R, Kamath AJ. Clinical profile and successful outcomes of conservative and minimally invasive treatment of emphysematous pyelonephritis. Cent European J Urol 2018; 71:228-233. [PMID: 30038815 PMCID: PMC6051364 DOI: 10.5173/ceju.2018.1639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/01/2018] [Accepted: 04/12/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) is a rare clinical entity, characterized by gas in the renal system, due to an acute, fulminant and potentially fatal necrotizing process with varying clinical presentations. It is much more aggressive than uncomplicated pyelonephritis, with the mortality of 20-40% in the contemporary meta-analysis. MATERIAL AND METHODS A retrospective record review of inpatients at the Institute of Nephro Urology, Bangalore, India (2007-2014), who were treated after EPN was diagnosed with the aid of a CT (computed tomography) scan. RESULTS Sixty-six patients (M:F 27:39) treated for EPN over the past seven years with the mean (±SD) age of 52.32 (±12.48) years were analyzed. Median (interquartile range) duration of hospital stay was 8 (11.25) days with 4 (6%) patients requiring intensive care unit admission (median, IQR = 5.5, 1.5 days) of whom two passed away due to septicemia. Fifty-six (84.85%) patients were diabetics, forty (60.6%) patients had estimated glomerular filtration rate (eGFR) <60 ml/min/1.7 3 m2, 6 (9.1%) patients had eGFR <30 ml/min/1.73 m2 including 3 (4.5%) with eGFR <15 ml/min/1.73 m2 requiring hemodialysis and twenty-two (33%) had thrombocytopenia. Fifty (75.76%) patients were classified as Huang and Tseng Class 2, 7 (10%) as Class 3 with perinephric abscess requiring open drainage and 9 (13.64%) had bilateral EPN (Class 4). Majority (43; 65%) responded to piperacillin-tazobactam treatment. Double J stenting was done in 17 (25.76%) patients, percutaneous drainage in 5 (7.58%) patients and nephrectomy in 2 (3%) patients. CONCLUSIONS Although EPN historically carries high morbidity and mortality, modern day medical management with timely intervention in the form of urinary drainage is effective and curative in most patients resulting in a low mortality rate.
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Affiliation(s)
| | | | - Ashwin Mallya
- Department of Urology, Insititute of Nephro Urology, Bangalore, India
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Rao CC, Rangappa P, Rao K, Jacob I. Outcome of Patients Admitted to a Tertiary Referral Intensive Care Unit with Urosepsis Needing Source Control. Indian J Crit Care Med 2018; 22:27-29. [PMID: 29422729 PMCID: PMC5793018 DOI: 10.4103/ijccm.ijccm_322_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Urosepsis is one of the common causes of admission to the Intensive Care Unit (ICU). It has traditionally been treated with antibiotics, but surgical management with Double J [DJ] ureteral stents is gaining popularity. This study compares patients with complicated urosepsis who underwent surgical source control by ureteral stenting with those managed medically. Materials and Methods: The study enrolled patients admitted to a tertiary adult ICU with a diagnosis of urosepsis over a period of 2 years. The primary outcomes were renal replacement therapy (RRT) requirement and ICU mortality. The secondary outcomes were ICU and hospital length of stay, ventilator-free days, and inotrope free days. Patients were divided those with obstructive and nonobstructive urinary tract infection (UTI). Results: A total of 58 patients met the criteria, of who 32 had obstructive UTI and were included in Group A, with the remaining 26 with nonobstructive UTI comprised Group B. In Group A, 27 patients underwent source control with ureteral DJ stenting, three patients recovered with medical management, and two who were advised source control did not consent to the procedure. Seventeen patients in Group A and seven patients in Group B required RRT (P = 0.044). There was no significant difference in ICU mortality, hospital mortality, and 28 days survival between the two groups. Conclusion: With early source control, obstructive UTI outcomes were comparable to nonobstructive UTI. However, despite undergoing ureteric stenting, more patients with obstructive UTI required RRT than those with nonobstructive UTI.
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Affiliation(s)
- Chaitra C Rao
- Department of Intensive Care, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
| | - Pradeep Rangappa
- Department of Intensive Care, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
| | - Karthik Rao
- Department of Intensive Care, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
| | - Ipe Jacob
- Department of Intensive Care, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
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Puvvada S, Arjun N, Mylarappa P, Gowda RD. A prospective analysis of emphysematous pyelonephritis at a tertiary care centre. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817752854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the presentation and diagnostic criteria of emphysematous pyelonephritis and different modalities of their management at our instititute. Methods: A prospective study of 5 years in which patients who were diagnosed to have emphysematous pyelonephritis confirmed by a non contrast CT presenting at our centre were included in this study and baseline information, a brief clinical history with a written consent was collected from each patient. The course of the patient along with investigations and interventions done from admission were recorded. Results: 72 patients were included in this study with a mean age of 55.4 +/-12.1 years (30 to 75 years ), comprising of 47 females and 25 males. Common presentation was tachycardia (94.5 %) and fever associated with burning micturition (75.3%) followed by loin pain on the affected side (71%). 31 cases which formed a majority were diagnosed to have right sided emphysematous pyelonephritis (41.9%), 28 had left sided (38.35%) and 14 bilateral (19.17%) in our series. 90.41 % of the patient were diagnosed to have diabetes mellitus of which 34 patients (46.57 %) presented with high sugars. Urine cultures were positive in only 41% of the patients with the most common organism being E. coli (68%) followed by Klebsiella pneumoniae (14%). 64.8% of the patients diagnosed were treated conservatively with IV antibiotics and 34.24% by endoscopic management. Conclusions: In this study we have shown that a medical line of management with appropriate endoscopic intervention is the present choice of management of emphysematous pyelonephritis irrespective of the CT grade of the disease. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - N Arjun
- Department of Urology, M.S. Ramaiah Medical College, India
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Oliveira CC, Garcia PD, Viero RM. Emphysematous pyelonephritis in a transplanted kidney. AUTOPSY AND CASE REPORTS 2017; 6:41-47. [PMID: 28210573 PMCID: PMC5304561 DOI: 10.4322/acr.2016.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 10/30/2016] [Indexed: 12/25/2022] Open
Abstract
Emphysematous pyelonephritis is a rare infection characterized by necrosis and gas accumulation in the renal parenchyma, adjacent tissues, and/or urinary collecting system. This entity is rarely reported in transplanted kidneys. Computed tomography imaging is necessary for diagnosis and risk classification. The authors described the case of a 58-year-old man who underwent a kidney transplant and presented sepsis from a urinary tract infection. An abdominal tomography showed some characteristics of emphysematous pyelonephritis associated with an abscess. A graft biopsy, performed 45 days after the transplant, failed to show signs of infection, and tubule-interstitial and vascular rejection were ruled out. The patient had a poor outcome, and a nephrectomy was needed, the pathological analysis of which yielded the diagnosis of chronic pyelonephritis with necrotizing papillitis. The patient became hemodynamically unstable and died. The authors highlight the current tomographic criteria for the diagnosis and treatment of emphysematous pyelonephritis and question the validity of accepting the same standards used to guide the treatment of patients without transplants, and call attention to the importance of the clinical status for the indication of nephrectomy in cases of emphysematous pyelonephritis.
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Affiliation(s)
- Cristiano Claudino Oliveira
- Department of Pathology - Botucatu School of Medicine - Universidade Estadual Paulista "Júlio de Mesquita Filho" - Botucatu/SP, Brazil
| | - Paula Dalsoglio Garcia
- Department of Internal Medicine - Botucatu School of Medicine - Universidade Estadual Paulista "Júlio de Mesquita Filho" - Botucatu/SP, Brazil
| | - Rosa Marlene Viero
- Department of Pathology - Botucatu School of Medicine - Universidade Estadual Paulista "Júlio de Mesquita Filho" - Botucatu/SP, Brazil
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Emphysematous Pyelonephritis: a Review of a Rare Condition. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0303-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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