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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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Hegde AV, Kaul NK, Parab S, Jain TP, Andankar M, Pathak HR. Hung up with a Huang class 4: our experience with bilateral emphysematous pyelonephritis in a COVID 19 patient. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:397-402. [PMID: 34796256 PMCID: PMC8595086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
The COVID 19 pandemic has forced us to rethink our management strategies for surgical diseases. Patients with COVID 19 have increased risk of morbidity and mortality after surgical intervention. Emphysematous pyelonephritis (EPN) is often seen in diabetics and can be a life threatening condition. All patients require immediate treatment with antibiotics and close monitoring. Bilateral EPN is a rare entity seen in less than 10% of patients. We present a case of bilateral EPN in a COVID positive patient which was successfully managed conservatively. A 70 year old hypertensive female, presented to us with fever, breathlessness, loss of appetite, generalised weakness requiring oxygen supplementation & was diagnosed with COVID 19. Bilateral EPN (Grade 4) with perinephric collections was found on evaluation for acute kidney injury. She underwent bilateral pig tail insertion followed by bilateral DJ stenting after stabilization. She recovered dramatically, blood parameters improved and was discharged. At 1 year of follow up, patient was doing well. In the present COVID-19 pandemic where case selection for surgical intervention is crucial, we would like to highlight how a conservative approach for even Class 4 EPN is feasible after weighing the risks and benefits of the same. Patients can be spared the immediate morbidity and mortality risks due to surgical intervention during COVID 19 infection. Triaging surgical intervention can also help in better utilization of critical care facilities and man power, both invaluable in the ongoing crisis.
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Affiliation(s)
- Abheesh Varma Hegde
- Department of Urology & Renal Transplantation, BYL Nair Ch. Hospital & Topiwala National Medical College Dr. A Nair Road, Mumbai 400008, India
| | - Naresh Kumar Kaul
- Department of Urology & Renal Transplantation, BYL Nair Ch. Hospital & Topiwala National Medical College Dr. A Nair Road, Mumbai 400008, India
| | - Sandesh Parab
- Department of Urology & Renal Transplantation, BYL Nair Ch. Hospital & Topiwala National Medical College Dr. A Nair Road, Mumbai 400008, India
| | - Tarunkumar Prakash Jain
- Department of Urology & Renal Transplantation, BYL Nair Ch. Hospital & Topiwala National Medical College Dr. A Nair Road, Mumbai 400008, India
| | - Mukund Andankar
- Department of Urology & Renal Transplantation, BYL Nair Ch. Hospital & Topiwala National Medical College Dr. A Nair Road, Mumbai 400008, India
| | - Hemant Ranganath Pathak
- Department of Urology & Renal Transplantation, BYL Nair Ch. Hospital & Topiwala National Medical College Dr. A Nair Road, Mumbai 400008, India
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Sengupta S, Basu S. Outcome of conservative and minimally invasive management in emphysematous pyelonephritis. Urol Ann 2021; 13:277-281. [PMID: 34421265 PMCID: PMC8343272 DOI: 10.4103/ua.ua_85_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022] Open
Abstract
Context: Developing countries. Introduction: Emphysematous pyelonephritis (EPN) is a urologic emergency characterized by acute necrotizing infection with the presence of gas in the kidney, perinephric space, and/or urinary collecting system. Materials and Methods: It is a retrospective study of inpatients at the Department of Urology, RG Kar Medical College and Hospital, Kolkata, which includes twenty patients diagnosed as EPN between September of 2018 and May of 2020. Results: Patients were classified as per computed tomography (CT) severity grading proposed by Huang and Tseng. In our study, medical management with antibiotics was effective in 10% of patients. Twenty percent of patients were treated with medical management and internal ureteral stenting. Fifty percent of the patients were treated with medical management and percutaneous nephrostomy (PCN). Ten percent needed PCN drainage in addition to Double J (DJ) stenting. Ten percent needed percutaneous drainage of perinephric abscess along with PCN. Ten percent of patients were treated with open drainage in addition to DJ stenting and percutaneous drainage of perinephric collection as they failed to respond to minimally invasive intervention alone, with repeat ultrasonography showing persistent collection. There was no mortality in the group. Conclusion: EPN patients are mostly moribund with multiple comorbidities. It is vital to comprehend the management with a prompt CT imaging. Proactive hemodynamic stabilization, antimicrobial therapy, complementing it with DJ stenting and/or PCN in cases not responding to antibiotics alone, can treat most of the patients with this pathology.
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Affiliation(s)
- Soumish Sengupta
- Department of Urology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Supriyo Basu
- Department of Urology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
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Dekaboruah E, Suryavanshi MV, Chettri D, Verma AK. Human microbiome: an academic update on human body site specific surveillance and its possible role. Arch Microbiol 2020; 202:2147-2167. [PMID: 32524177 PMCID: PMC7284171 DOI: 10.1007/s00203-020-01931-x] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/21/2022]
Abstract
Human body is inhabited by vast number of microorganisms which form a complex ecological community and influence the human physiology, in the aspect of both health and diseases. These microbes show a relationship with the human immune system based on coevolution and, therefore, have a tremendous potential to contribute to the metabolic function, protection against the pathogen and in providing nutrients and energy. However, of these microbes, many carry out some functions that play a crucial role in the host physiology and may even cause diseases. The introduction of new molecular technologies such as transcriptomics, metagenomics and metabolomics has contributed to the upliftment on the findings of the microbiome linked to the humans in the recent past. These rapidly developing technologies are boosting our capacity to understand about the human body-associated microbiome and its association with the human health. The highlights of this review are inclusion of how to derive microbiome data and the interaction between human and associated microbiome to provide an insight on the role played by the microbiome in biological processes of the human body as well as the development of major human diseases.
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Affiliation(s)
- Elakshi Dekaboruah
- Department of Microbiology, Sikkim University, Gangtok, Sikkim, 737102, India
| | | | - Dixita Chettri
- Department of Microbiology, Sikkim University, Gangtok, Sikkim, 737102, India
| | - Anil Kumar Verma
- Department of Microbiology, Sikkim University, Gangtok, Sikkim, 737102, India.
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Seker KG, Arikan Y, Cetin Seker Y, Ozlu DN, Evren I. An Unexpected Complication After Extracorporeal Shock Wave Lithotripsy: Emphysematous Pyelitis. Cureus 2020; 12:e8307. [PMID: 32607291 PMCID: PMC7320654 DOI: 10.7759/cureus.8307] [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] [Indexed: 11/11/2022] Open
Abstract
Emphysematous urinary tract infections (UTI) are life-threatening conditions caused by gas-forming organisms. Emphysematous pyelitis (EP) is a rare, acute bacterial UTI characterized by gas formation only in the renal collecting system. Extracorporeal shock wave lithotripsy (ESWL) treatment was performed for 10-mm sized stone in the left renal pelvis in an 81-year-old female patient with no known comorbidities other than hypertension. In the 10th hour following ESWL treatment, the patient referred to the emergency department with fever and left flank pain. Gas was noticed in the left renal collecting system in non-contrast computed tomography (NCCT). A wide spectrum antibiotic was given to the patient due to EP diagnosis and a nephrostomy catheter was placed in the left renal pelvis. EP should be considered in the patient with fever and flank pain after ESWL and NCCT should be performed for further examination. Quick diagnosis, examination and treatment of these patients in the emergency department are important.
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Affiliation(s)
- Kamil Gokhan Seker
- Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Yusuf Arikan
- Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | | | - Deniz Noyan Ozlu
- Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Ismail Evren
- Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, İstanbul, TUR
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Emphysematous pyelonephritis caused by candida species: A case report and outcome of 1 year follow-up. Urol Case Rep 2020; 30:101113. [PMID: 32055447 PMCID: PMC7005417 DOI: 10.1016/j.eucr.2020.101113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/06/2020] [Indexed: 11/24/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is an acute life-threatening gas-forming necrotizing infection of the renal parenchyma and its surrounding tissues. EPN requires early diagnosis and management because of related life-threatening septic complications. Gram-negative bacteria remain the most common causative organisms. Although candida species as a causative pathogen in emphysematous pyelonephritis is very rare, we report a rare case of emphysematous pyelonephritis caused by candida species successfully managed with unilateral nephrectomy and outcome for flow up in one year.
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Tatakis FP, Kyriazis I, Panagiotopoulou IE, Kalafatis E, Mantzikopoulos G, Polyzos K, Kachrimanidis I, Vogiatzakis AM, Rellou S, Manta E, Tzaki M, Papaioannou V, Lelekis M. Simultaneous Diagnosis of Emphysematous Osteomyelitis and Emphysematous Pyelonephritis in a Diabetic Patient. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1793-1796. [PMID: 31787744 PMCID: PMC6913288 DOI: 10.12659/ajcr.920006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Emphysematous osteomyelitis of the spine is characterized by intravertebral or intraosseous air. Emphysematous pyelonephritis (EP) is the infection of the renal parenchyma and perirenal tissues caused by gas forming microorganisms and thus is characterized by gas formation. Prompt diagnosis and initiation of necessary treatment is crucial, as both entities are associated with high mortality rates. CASE REPORT A 57-year-old female with uncontrolled hyperglycemia presented to the emergency department with history of sudden onset of weakness, nausea, vomiting and diarrhea for 3 days and with a fall on the same level the previous day. Laboratory examinations revealed leukocytosis, lymphopenia, thrombocytopenia, deteriorated renal function, and hyperglycemic hyperosmolar non-ketotic state. She was placed on aggressive intravenous hydration and insulin infusion pump. Due to the deterioration of her medical condition, she underwent abdominal and pelvic CT scanning that revealed emphysematous osteomyelitis of the spine and emphysematous pyelonephritis. Despite vigorous fluid resuscitation and systemic broad-spectrum antibiotic therapy, the patient's condition deteriorated further and eventually led to death within 48 h. CONCLUSIONS This case of fatal emphysematous osteomyelitis of the spine and EP serves as a significant reminder of those rare life-threatening entities, which affect patients with comorbidities, such as diabetes mellitus and other etiologies causing immunosuppression. The aim of the present case report is to highlight the importance and contribution of computed tomography in diagnosing these conditions and to emphasize the rare coexistence of these 2 emphysematous entities.
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Affiliation(s)
| | - Ioannis Kyriazis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece.,Diabetes and Obesity Outpatient Clinic, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Emmanuel Kalafatis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Konstantinos Polyzos
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | | | | | - Sofia Rellou
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | - Eleni Manta
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | - Maria Tzaki
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Moyssis Lelekis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
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Umair M. Emphysematous pyelitis in a solitary functioning kidney. Urol Case Rep 2019; 26:100934. [PMID: 31211095 PMCID: PMC6565605 DOI: 10.1016/j.eucr.2019.100934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/20/2022] Open
Abstract
The present report describes the case of a 53-year-old male patient with solitary functioning right kidney admitted to the emergency room with acute abdominal pain, deranged blood sugar, and fever (38.5 °C). Laboratory investigations and computed tomography findings revealed urinary tract infection, deranged renal functions, raised inflammatory markers associated with the presence of gas in the collecting system, characterizing unilateral emphysematous pyelitis caused by Gram-negative bacteria. The present case report emphasizes the occurrence of this disease as a deranged blood glucose complication.
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Bilateral emphysematous pyelonephritis cured by antibiotics alone in a black African woman. Radiol Case Rep 2018; 13:848-854. [PMID: 30002786 PMCID: PMC6040232 DOI: 10.1016/j.radcr.2018.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/24/2018] [Accepted: 05/26/2018] [Indexed: 12/27/2022] Open
Abstract
A 78-year-old black woman with a 10-year history of diabetes mellitus was admitted to the intensive care unit. Upon admission, she presented with chills, nausea, and left flank pain. The presence of hyperglycemia (fasting blood glucose, 19.7 mmol/L) and an altered consciousness required immediate treatment with insulin analog. Laboratory investigations and enhanced computed tomography scan led to the diagnosis of bilateral emphysematous pyelonephritis (EPN). The patient responded well to conservative treatment with antibiotics, and was finally discharged after 22 days when the computed tomography scan showed resolution of all the pockets of air. This case and associated literature review of 25 previously reported cases of bilateral EPN show the changing trend of EPN management from emergency nephrectomy toward conservative treatment with potent antibiotics and/or percutaneous drainage, and has been associated with higher survival rates compared to emergency nephrectomy.
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Uruc F, Yuksel OH, Sahin A, Urkmez A, Yildirim C, Verit A. Emphysematous pyelonephritis: Our experience in managing these cases. Can Urol Assoc J 2015; 9:E480-3. [PMID: 26279720 DOI: 10.5489/cuaj.2828] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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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Affiliation(s)
- Fatih Uruc
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
| | | | - Aytac Sahin
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
| | - Ahmet Urkmez
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
| | - Caglar Yildirim
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
| | - Ayhan Verit
- Fatih Sultan Mehmet Research and Training Hospital, Istanbul
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Suzuki R, Abe T, Uchida H, Niikura K. Successful management of bilateral emphysematous pyelonephritis with abscess formation in a chronic hemodialysis patient: a case report. CEN Case Rep 2015; 4:90-94. [PMID: 28509282 DOI: 10.1007/s13730-014-0146-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
Abstract
Bilateral emphysematous pyelonephritis (EPN) has seldom been reported in patients on maintenance hemodialysis (HD). Percutaneous catheter drainage (PCD) or nephrectomy is often required in the treatment of bilateral EPN because of its poor response to antimicrobial agents and high mortality rate. We report a patient with bilateral EPN on maintenance HD. An octogenarian man with diabetes mellitus who had previously undergone regular HD for 22 months was admitted to our hospital because of severe inflammation resulting from bilateral EPN. His lesions of EPN had resulted in abscess formation in both kidneys and right and left side retroperitoneal space. As patient refused interventional therapy including nephrectomy or PCD, he was treated conservatively. After treatment with several antimicrobial agents for 50 days, he completely recovered from bilateral EPN. To our knowledge, this is the first case report of successful conservative management (antimicrobial therapy alone) of bilateral EPN that developed in a chronic diabetic HD patient.
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Affiliation(s)
- Ryuji Suzuki
- Department of Internal Medicine, Hitotsubashi Hospital, 1-2-25 Gakuen Nishimachi, Kodaira-shi, Tokyo, 187-0045, Japan.
| | - Takehiko Abe
- Department of Radiology, Japan Anti-Tuberculosis Association, Fukujuji Hospital, 3-1-24 Matsuyama, Kiyoshe-shi, Tokyo, 204-8522, Japan
| | - Hiroji Uchida
- Department of Urology, Hitotsubashi Hospital, 1-2-25 Gakuen Nishimachi, Kodaira-shi, Tokyo, 187-0045, Japan
| | - Kazuhiko Niikura
- Department of Internal Medicine, Hitotsubashi Hospital, 1-2-25 Gakuen Nishimachi, Kodaira-shi, Tokyo, 187-0045, Japan
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Vlachopanos G, Kassimatis T, Zerva A, Kokkona A, Stavroulaki E, Zacharogiannis C, Agrafiotis A. Successful medical treatment of emphysematous pyelonephritis in chronic hemodialysis. Hemodial Int 2015; 19:E54-8. [PMID: 25643771 DOI: 10.1111/hdi.12274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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.
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Affiliation(s)
| | | | - Adamantia Zerva
- Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece
| | - Anastasia Kokkona
- Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece
| | - Eirini Stavroulaki
- Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece
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Kumar S, Ramachandran R, Mete U, Mittal T, Dutta P, Kumar V, Rathi M, Jha V, Gupta KL, Sakhuja V, Kohli HS. Acute pyelonephritis in diabetes mellitus: Single center experience. Indian J Nephrol 2014; 24:367-71. [PMID: 25484530 PMCID: PMC4244716 DOI: 10.4103/0971-4065.135347] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Diabetes mellitus is a common cause of pyelonephritis. Both emphysematous pyelonephritis (EPN) and non-EPN (NEPN) are associated with poor outcome. This study was aimed at analyzing the clinical features, microbiological profile, prognostic factors, and treatment outcome of pyelonephritis in diabetic patients. A total of 105 diabetic patients with pyelonephritis were admitted from July 2010 to June 2012. Patients were treated with appropriate antibiotics and percutaneous drainage (PCD) as indicated. Nephrectomy was carried out in patients of EPN who were refractory to conservative measures. NEPN and EPN were seen in 79 (75.2%) and 26 (24.7%) patients, respectively. Escherichia coli was the most common organism. Pyelonephritis was associated with renal abscess and papillary necrosis in 13 (12.4%) and 4 (3.8%) patients with EPN and NEPN, respectively. Worsening of renal functions were seen in 92 and 93% of patients with EPN and NEPN, respectively. Class 1 EPN was seen in 2 (7.7%), Class II in 8 (30.7%), IIIa in 7 (27%), IIIb in 5 (19.3), and IV in 4 (15.4%) patients. Antibiotics alone were sufficient in 38.5% of EPN versus 62% in NEPN; additional PCD was required in 42.3% in EPN and 21.4% in NEPN. Nephrectomy was required in 5 (19.2%) EPN patients with Class IIIB or IV. A total of 13 patients (12.4%) expired, 4 (15.4%) in EPN, and 9 (11.4%) in NEPN group. Patients with EPN had a higher incidence of shock (6% vs. 0; P < 0.05) and poorly controlled blood sugar (26% vs. 50%; P < 0.05) compared with NEPN. Presence of shock and altered sensorium were associated with poor outcome in patients with EPN. Diabetics with pyelonephritis have severe disease. Patients of EPN have poorer treatment outcome compared with those with NEPN. However, there is no difference in the mortality, but a greater need of nephrectomy in EPN compared with NEPN patients. Presence of shock and altered sensorium at presentation were poor prognostic factors in EPN.
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Affiliation(s)
- S Kumar
- Department of Nephrology, PGIMER, Chandigarh, India
| | | | - U Mete
- Department of Urology, PGIMER, Chandigarh, India
| | - T Mittal
- Department of Nephrology, PGIMER, Chandigarh, India
| | - P Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - V Kumar
- Department of Nephrology, PGIMER, Chandigarh, India
| | - M Rathi
- Department of Nephrology, PGIMER, Chandigarh, India
| | - V Jha
- Department of Nephrology, PGIMER, Chandigarh, India
| | - K L Gupta
- Department of Nephrology, PGIMER, Chandigarh, India
| | - V Sakhuja
- Department of Nephrology, PGIMER, Chandigarh, India
| | - H S Kohli
- Department of Nephrology, PGIMER, Chandigarh, India
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Nasr AA, Kishk AG, Sadek EM, Parayil SM. A case report of emphysematous pyelonephritis as a first presentation of diabetes mellitus. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e10384. [PMID: 24693378 PMCID: PMC3955493 DOI: 10.5812/ircmj.10384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/07/2013] [Indexed: 11/23/2022]
Abstract
Emphysematous Pyelonephritis (EPN) is an acute suppurative Infection of the kidney. It is an uncommon infection, occurs mostly in patients with diabetes and a predilection for females. It has a high fatality rate; therefore, aggressive medical, early intervention or surgical approach is recommended. We present here a woman with no previous medical history presented with uncontrolled hyperglycemia for the first time associated with EPN.
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Affiliation(s)
- Amal Ali Nasr
- Medical Department, Amiri Hospital, Kuwait City, Kuwait
| | - Ashraf Gaber Kishk
- Medical Department, Amiri Hospital, Kuwait City, Kuwait
- Corresponding Author: Ashraf Gaber Kishk, Medical Department, Amiri Hospital, Kuwait City, Kuwait. Tel/Fax: +96-597310234, E-mail:
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Medical therapy alone can be sufficient for bilateral emphysematous pyelonephritis: report of a new case and review of previous experiences. Int Urol Nephrol 2013; 46:223-7. [PMID: 23591724 DOI: 10.1007/s11255-013-0446-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/08/2013] [Indexed: 12/11/2022]
Abstract
Bilateral emphysematous pyelonephritis (EPN) is an extremely uncommon, life-threatening gas-forming infection of renal parenchyma and its surrounding areas. Surgical treatment, including percutaneous catheter drainage and nephrectomy, has been advocated as the treatment of choice in most of the patients. However, nephrectomy is itself a hazardous intervention in an unstable septic patient. Whenever bilateral disease is present, the need for long-term renal replacement therapy is unavoidable. We present the clinical course of a lady who presented with bilateral EPN and was successfully managed by medical therapy alone. We also reviewed almost all published cases of bilateral EPN that had been managed medically.
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Kolla PK, Madhav D, Reddy S, Pentyala S, Kumar P, Pathapati RM. Clinical profile and outcome of conservatively managed emphysematous pyelonephritis. ISRN UROLOGY 2012; 2012:931982. [PMID: 22567427 PMCID: PMC3329657 DOI: 10.5402/2012/931982] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 01/11/2012] [Indexed: 12/11/2022]
Abstract
Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal parenchymal infection characterized by production of intraparenchymal gas. EPN predominantly affects female diabetics and immunocompromised patients. In a three-year period 2008-2011, a total of 8 patients were admitted to our hospital. All of them were diabetics, and both males and females were equally affected. These patients showed vague symptoms at admission and frequently presented with fever, loin pain, dysuria, and pyuria necessitating urgent medical attention. EPN required radiological diagnosis. CT scan revealed bilateral EPN with urinary obstruction and hydronephrosis in 50% of patients. Escherichia coli was found to be the causative organism in all the patients. Treatment comprised of resuscitation, normalization of serum electrolytes and blood sugars, administration of parenteral antibiotics, and relieving ureteric obstruction if present. All the patients improved with conservative management without any mortality.
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Affiliation(s)
- Praveen Kumar Kolla
- Department of Nephrology, Narayana Medical College Hospital, Chinthareddypalem, Andhra Pradesh, Nellore 524002, India
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Laway BA, Bhat MA, Bashir MI, Ganie MA, Mir SA, Daga RA. Conservative management of emphysematous pyelonephritis. Indian J Endocrinol Metab 2012; 16:303-305. [PMID: 22470875 PMCID: PMC3313756 DOI: 10.4103/2230-8210.93776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Emphysematous pyelonephritis, though uncommon, is a severe necrotizing kidney infection common in patients with diabetes. Surgical treatment has been advocated as the treatment of choice in most of the patients. We present the clinical course of an elderly lady who presented with emphysematous pyelonephritis and was successfully managed with medical treatment despite the presence of adverse prognostic factors like acute renal failure and thrombocytopenia.
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Affiliation(s)
- Bashir Ahmad Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Manzoor Ahmad Bhat
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Mir Iftikhar Bashir
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Mohd Ashraf Ganie
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Shahnaz Ahmad Mir
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Riyaz Ahmad Daga
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Benelhoul W, Basset T, Salhi MS, Kallel H, Hommel D. [Emphysematous pyelonephritis: a rare complication of upper urinary tract infections]. ACTA ACUST UNITED AC 2012; 31:262-3. [PMID: 22305396 DOI: 10.1016/j.annfar.2011.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 11/22/2011] [Indexed: 11/29/2022]
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Abstract
Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal parenchymal infection that is characterized by the production of intraparenchymal gas. EPN predominantly affects female diabetics, and can occur in insulin-dependent and non-insulin-dependent patients in the absence of ureteric obstruction. Nondiabetic patients can also develop EPN, but often have ureteric obstruction and do not seem to develop such extensive disease. One gaseous component-carbon dioxide-is generated by bacterial fermentation of glucose (present in excess in diabetics) and acids. Patients with EPN show relatively vague symptoms initially, but frequently undergo a sudden deterioration in their condition, necessitating urgent medical attention. Treatment of patients with EPN comprises resuscitation, correction of any electrolyte and glucose problems, and administration of antibiotics targeting Gram-negative bacteria. Ureteric obstruction, if present, is relieved by a percutaneous nephrostomy or stent. Definitive management is by percutaneous drainage, except when there is extensive diffuse gas with renal destruction; in this case, a nephrectomy is advised. The requirement for a nephrectomy could potentially be avoided by early diagnosis and treatment of diabetics with urinary infection. With the advent of CT, a staging system of the gas patterns generated in the kidneys of EPN patients has evolved. Risk factors have been defined to aid management.
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Mohsin N, Budruddin M, Lala S, Al-Taie S. Emphysematous pyelonephritis: a case report series of four patients with review of literature. Ren Fail 2010; 31:597-601. [PMID: 19839858 DOI: 10.1080/08860220903003396] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is an acute necrotizing infection with gas presence in the kidney, perinephric space, and/or urinary collecting system that carries a bad prognosis. Some clinical conditions predispose to this entity, such as diabetes mellitus, urinary tract obstruction, and immune-incompetence. Immediate resuscitation, broad-spectrum antibiotics, percutaneous and surgical drainage, and emergent and delayed nephrectomy are therapeutic options that should be applied in a timely fashion. We report our experience of four patients with EPN. Two of the patients were kidney transplant recipients, one patient had bilateral urolithiasis, and one patient was an elderly patient with debilitated general condition and an abdominal mass that could not be defined. Late transplant nephrectomy was performed in one patient, and three patients were treated conservatively. Three patients died, including the patient who had transplant nephrectomy. One patient who presented with lithiasis showed a remarkable recovery with conservative management. The bacteria involved were E. Coli and a resistant Klebsiella. We conclude that EPN is a life-threatening condition that carries a bad prognosis. Early diagnosis is essential for a positive outcome. Therapeutic measures should be applied immediately after diagnosis. An aggressive approach including nephrectomy may be emergently required.
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Affiliation(s)
- N Mohsin
- Department of Nephrology, Royal Hospital, Muscat, Oman.
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Park BS, Lee SJ, Kim YW, Huh JS, Kim JI, Chang SG. Outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis. ACTA ACUST UNITED AC 2009; 40:332-8. [PMID: 16916776 DOI: 10.1080/00365590600794902] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of the kidney characterized by gas formation. In order to compare the outcome of nephrectomy and kidney-preserving procedures for the treatment of EPN we reviewed our experiences of EPN over the past 18 years. MATERIAL AND METHODS The medical records of 17 patients with EPN treated between October 1986 and September 2004 were retrospectively reviewed. Abdominal X-ray and/or CT were used as diagnostic methods. RESULTS Women outnumbered men (12 vs five), and all patients had diabetes. Obstruction of the corresponding reno-ureteral unit was found in one patient. Thirteen of the 17 patients (76%) had poorly controlled diabetes (hemoglobin A1c>7%). The diagnosis of EPN was confirmed by gas in the parenchymal or perinephric space as detected by abdominal X-ray or CT. Escherichia coli was the commonest organism present in urine cultures (52%), followed by Klebsiella pneumoniae (24%). Prompt efforts were made to control diabetes, and i.v. antibiotics were given. Nephrectomy was performed in 10 patients and nine patients survived (90% success rate). The success rate among those who received medical therapy only was 50% (2/4 patients). Percutaneous drainage was performed in three patients, two of whom survived (67% success rate). The overall mortality rate was 17.6% (3/17 patients). CONCLUSIONS Immediate nephrectomy with glycemic control measures and antibiotic administration is crucial for the successful treatment of EPN. However, in inoperable cases, percutaneous drainage can be an effective treatment option.
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Affiliation(s)
- Bum Soo Park
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, South Korea
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Kumar N, Singh NP, Mittal A, Valson AT, Hira HS. An uncommon cause of postpartum renal failure--bilateral emphysematous pyelonephritis. Ren Fail 2009; 31:171-4. [PMID: 19212918 DOI: 10.1080/08860220802598082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Peripartum acute renal failure is an important complication related to pregnancy leading to significant morbidity and mortality. Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma, with formation of gas within the collecting system, renal parenchyma, or perirenal tissues. EPN is common in persons with diabetes or urinary tract obstruction. Herein we report a case of bilateral emphysematous pyelonephritis in a postpartum lady who had no evidence of diabetes or urinary tract obstruction. Management of this condition has traditionally been aggressive, and surgery has been considered mandatory. Our patient was managed successfully with antibiotics and supportive measures alone.
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Affiliation(s)
- Naresh Kumar
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Su YJ, Lai YC, Chang WH. Bilateral emphysematous pyelonephritis in a post-polio syndrome man. J Emerg Med 2008; 35:309-12. [PMID: 18291613 DOI: 10.1016/j.jemermed.2007.07.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 12/28/2006] [Accepted: 07/03/2007] [Indexed: 02/07/2023]
Affiliation(s)
- Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Medical Center, Taipei, Taiwan
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Ganie MA, Masoodi SR, Laway BA, Misger RA, Wani AI, Bashir MI, Zargar AH. Emphysematous pyelonephritis in diabetes mellitus: a series of five cases. Diabetes Res Clin Pract 2007; 78:143-4. [PMID: 17367890 DOI: 10.1016/j.diabres.2007.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 02/10/2007] [Indexed: 11/19/2022]
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Mokabberi R, Ravakhah K. Emphysematous urinary tract infections: diagnosis, treatment and survival (case review series). Am J Med Sci 2007; 333:111-6. [PMID: 17301591 DOI: 10.1097/00000441-200702000-00009] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Emphysematous urinary tract infections are rare conditions, usually occurring in diabetic patients. Mortality rates in medically managed patients are reported to be as high as 70% to 90%. Growth of the diabetic population warrants heightened attention to these potentially fatal infections. We report a series of 5 cases with favorable outcomes. CASE REPORTS All patients were diabetic. Presenting symptoms included fever, chills, nausea, vomiting, and abdominal pain. On physical examination, two patients had costovertebral angle tenderness; a third was dehydrated; a fourth had dehydration and an abdominal mass; and a fifth patient had suprapubic tenderness. All cases had leukocytosis and impaired renal function. Computed tomography (CT) scan disclosed emphysematous pyelonephritis in 3 cases (gas within renal parenchyma and/or perirenal tissue), emphysematous pyelitis in 1 case (gas in collecting system), and emphysematous cystitis in 1 patient (gas within bladder wall). Urine culture of 1 case grew Enterococci, whereas in the other cases cultures yielded gas-producing organisms. All patients received intravenous antibiotics. Two patients underwent CT-guided abscess drainage; 2 cases had J-stent placement, and one patient was readmitted with septic shock and underwent nephrectomy. All the patients' conditions improved and they were discharged. DISCUSSION Emphysematous urinary tract infections are usually caused by gas-producing organisms. They should be suspected in diabetic patients with urinary tract infections and worsening of renal function. CT scan is the method of choice for diagnosis and follow up. None of our patients died, mainly due to early diagnosis, sequential radiologic assessment, and timely surgical intervention when needed.
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Affiliation(s)
- Rasoul Mokabberi
- Department of Medicine, Huron Hospital, a Cleveland Clinic Hospital, Cleveland, Ohio 44112, USA.
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Medagama UAB, Aluvihare APR, Jayasinghe MWC, Rosairo S, Fernando DJS. A gas forming renal abscess in a person with diabetes mellitus and adult polycystic kidney disease. Diabetes Res Clin Pract 2007; 75:372-3. [PMID: 16962199 DOI: 10.1016/j.diabres.2006.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 07/06/2006] [Indexed: 11/29/2022]
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Nayeemuddin M, Wiseman OJ, Turner AG. Emphysematous pyelonephritis. ACTA ACUST UNITED AC 2006; 2:108-12. [PMID: 16474656 DOI: 10.1038/ncpuro0095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 01/11/2005] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 54-year-old nondiabetic male presented with high fever, vague lower abdominal pain and leakage of urine around his long-standing suprapubic catheter. Examination revealed pyrexia and tenderness in the right renal angle. White cell count was 22.8 x 10(9)/l. Plain abdominal X-ray showed calculi in the right kidney, ureter and bladder. Intravenous pyelogram showed gas confined to the right upper renal pelvis and perinephric space. INVESTIGATIONS Urine and blood cultures, plain abdominal X-ray, intravenous pyelogram, abdominal ultrasound, MAG3 renogram and histopathology. DIAGNOSIS Emphysematous pyelonephritis: class 2 or type 1. Escherichia coli was isolated from urine obtained by endoscopic drainage. MANAGEMENT Endoscopic drainage of pus and simple nephrectomy.
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Harandou M, Khatouf M, Bouhafa T, Kanjaa N, Leclercq G, Lapostolle F. Une pyélonéphrite emphysémateuse d'évolution favorable après traitement conservateur. ACTA ACUST UNITED AC 2005; 24:556-8. [PMID: 15904737 DOI: 10.1016/j.annfar.2005.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 01/18/2005] [Indexed: 11/19/2022]
Abstract
Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis is responsible for a high mortality rate. We report the case of a woman, unknown diabetic, who presented with emphysematous pyelonephritis. Early diagnosis performed by CT-scan allowed effective and conservative surgical treatment and final positive outcome.
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Affiliation(s)
- M Harandou
- Service de réanimation chirurgicale, hôpital Al-Ghassani, Fès, Morocco
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Abstract
Emphysematous pyelonephritis is a necrotizing kidney infection characterized by the presence of gas in renal parenchyma, collecting system or perinephric tissue. This rare affection occurs almost exclusively in patients with diabetes mellitus and is due to non-anaerobic gas-producing bacteria. This life-threatening condition leads to septic shock and multiple organ failure. Diagnosis is suspected when a pyelonephritis does not respond to correct treatment, especially with altered vital signs or a diabetic patient. Computed tomography scan permits visualization of the gas and a radiologic classification with a prognostic value. Current treatment modalities are based upon repeated clinical and scanographic evaluations. In addition to systematic antibiotic therapy, percutaneous drainage is probably the first therapeutic stage in the majority of cases, but should not delay emergent rescue nephrectomy if necessary.
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Affiliation(s)
- E Kaiser
- Anesthésiste-réanimateur des Hôpitau des Armées, département d'anesthésie-réanimation, France.
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