Bilateral emphysematous pyelonephritis

Emphysematous Pyelonephritis with Pneumocystitis

“…The clinical presentation of emphysematous pyelone phritis is similar to that of other patients with pyelone phritis [6,8]: fever with chills, flank pain, nausea and vomiting are the most common presenting symptoms. Pneumaturia is a rare symptom and is seen in bladder communicating conditions as in our case.…”

“…Any patients, particularly diabetics, with these listed clinical findings should be examined radiographically to rule out the pres ence of this disease [5]. The presence of gas inside the kidney and in the retroperitoneal space is nearly patho gnomonic [7], However, renal gas is sometimes mistaken for gas within the gastrointestinal tract on initial exami nations with the plain abdominal film and IUP [8]. Besides, IUP is rarely of value since the affected kidneydoes not function in most cases [6].…”

“…The causative organism is most commonly E. coli. However, Aerobacter aeruginosa, Pseudomonas and Klebsiella aerobacter have also been reported [4,7], Spontaneous gas formation in the urinary tract can be explained by four mechanisms: (1) Atmospheric gas allowance by iatrogenic manipulation; (2) gas in the upper urinary tract by the pathological communication with the gastrointestinal tract or pulmonary system; (3) anaerobic gas-forming organisms, such as Clostridia, as a consequence or urological operations, and (4) glu cose within the urinary tract can be fermented by mi croorganisms to form organic acids, carbon dioxide and hydrogen [5,8], The latter mechanism may be the causa tive factor for emphysematous pyelonephritis. However, the true pathogenesis of emphysematous pyelonephritis is still poorly understood.…”

“…In the absence of obstructive uropathy, management of the patient with emphysematous pyelonephritis should be intensive medical therapy of the infection, cor rection of the electrolyte imbalance and control of the diabetes if present [3,8], If response to medical therapy is inadequate, prompt surgical intervention should fol low. However, many investigators believe that the fre quent association with papillary necrosis in the contra lateral kidney is the most common pathological finding and one should observe closely patients who have under gone nephrectomy [5,8].…”

Successful Medical Treatment of Emphysematous Pyelonephritis in a Renal Allograft Recipient

“…[6] In most cases, the native kidneys are involved; either unilaterally or-in 10% of cases-bilaterally. [7] EPN involving the transplant kidney is rare. [8] The management of EPN has traditionally been aggressive and usually surgical.…”