Conservative management of emphysematous pyelonephritis

Laway, Bashir Ahmad; Bhat, Manzoor A.; Bashir, Muhammad Salman; Ganie, Mohd Ashraf; Mir, Shabir Ahmad; Daga, Riyaz Ahmad

doi:10.4103/2230-8210.93776

Cited by 11 publications

(13 citation statements)

References 10 publications

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“…1,8 Emphysematous pyelonephritis should be suspected in immunosuppressed patients or in patients with abnormal immune response, inadequate tissue perfusion, or poorly controlled diabetics. 2,4,5 Females are more likely to suffer a emphysematous pyelonephritis; although in renal transplantation, males are more likely to suffer. 5,6 Another issue to consider is the urinary tract.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, individual assessments yield better results. 2,4,5,7,8 We report a case of emphysematous pyelonephritis in a renal transplant recipient. We also review the other reported cases.…”

Section: Introductionmentioning

confidence: 99%

“…The main causal agent is gas-forming bacteria like Escherichia coli, Klebsiella pneumonia or Proteus mirabilis. [1][2][3] The disease may induce fever, pain, acute renal failure, septic shock or even death. 4 It is a rare disease, with a high mortality rate.…”

Section: Introductionmentioning

confidence: 99%

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Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment

Tienza

Hevia

Merino

et al. 2014

CUAJ

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Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney and perinephric space that carries a bad prognosis. Apart from its predisposing clinical entities, diabetes mellitus and immune-incompetence are quite common in patients with this infection. We report a case of a 53-year-old kidney transplant recipient diabetic male, suffering from recurrent fever, abdominal pain and nausea episodes. Immediate broad-spectrum antibiotics were administered and percutaneous drainage was performed after the diagnosis. The bacteria involved were Stahpylococcus epidermidis and Escherichia coli. After 4 weeks of antibiotic treatment and abscesses drainage, the case was resolved. Consecutives urine cultures and ultrasonographies confirm the complete resolution of the disease. We discuss the predisposing factors, clinical presentation and management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment

Tienza

Hevia

Merino

et al. 2014

CUAJ

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“…11 However there are growing reports of successful medical treatment of EPN. [12][13][14][15] According to these reports, our case could be considered treatable by antibiotics alone partly because of the rapid diagnosis and the adequate therapy provided.…”

Section: Discussionmentioning

confidence: 99%

Emphysematous pyelonephritis: a case report

et al. 2015

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Emphysematous pyelonephritis (EPN) is an acute severe necrotizing infection of the renal parenchyma and its surrounding areas, characterized by the presence of gas within the kidney and perinephric tissue. 1 It occurs almost exclusively in patients with diabetes mellitus.2,3 The disease predominantly affects women. Escherichia coli is the causative bacterial source in approximately 70% of the cases, with Klebsiella, Candida and Pseudomonas species less frequently isolated.4,5 Gas formation in EPN is due to pathogenic bacteria causing mixed acid fermentation in a hyperglycemic environment in tissues that are ischemic. The clinical manifestations are those of pyelonephritis such as dysuria, fever, nausea, vomiting, flank pain. Other potential clinical manifestations include acute renal dysfunction, hyperglycemia, thrombocytopenia, lethargy, acid-base irregularities. EPN is a life-threatening disease associated with septic complications. EPN requires a radiological diagnosis. Computed tomography (CT) is the imaging test of choice to confirm the presence and extent of the parenchymal gas. Case ReportA 68-year-old woman was admitted to the medical ward with a one-day history of left lower abdominal pain, vomiting and fever. She had a history of hypertension and type 2 diabetes mellitus, treated with oral anti-diabetic drugs. On examination she presented with fever (39.1°C), her blood pressure was 160/80 mm/Hg and the heart rate was 87 beats per minute. She had left flank pain, accentuated by local palpation. Cardiorespiratory examination was normal. She presented without any focal neurological deficit.Her blood tests showed renal impairment, decompensated diabetes, a high leukocyte count with a neutrophil segment, high inflammatory markers and a very high pro-calcitonin (Table 1). Urinalysis showed the presence of hyaline cylinders. Urine and blood samples were collected for bacterial culture analysis. A plain abdominal radiograph revealed no pathological findings; a renal ultrasound was performed revealing dilatation of the pelvicalyceal system and upper ureter of the left kidney (0.6 cm diameter). The patient was managed with intravenous fluids and insulin to achieve euglycemia. In suspicion of pyelonephritis, empiric intravenous antibiotics in the form of levofloxacin and meropenem were administered. A plain non-contrast CT (NCCT) scan demonstrated the presEmphysematous pyelonephritis: a case report ABSTRACTEmphysematous pyelonephritis is a severe, life-threatening, necrotizing kidney disease. It occurs almost exclusively in patients with diabetes mellitus. The clinical manifestations are those of pyelonephritis such as dysuria, fever, nausea, vomiting and abdominal pain. The diagnosis is radiological. The treatment strategies are controversial. They include medical management only, percutaneous catheter drainage plus medical management, emergency nephrectomy plus medical treatment or percutaneous drainage plus medical management and emergency nephrectomy. We present the case of a 68-year-old woman affected by e...

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“…Some patients remain on antibiotic therapy after intervention and the duration reported ranges from 10 days to 30 days depending on severity of the illness (Arsene et al, 2014). Oral antibiotics may be continued afterwards for one to three months (Best et al, 1999;Jain et al, 2000;Laway et al, 2012;Tahir et al, 2000). There are currently no established guidelines for recommended duration of antibiotics for EPN.…”

Section: Discussionmentioning

confidence: 99%

Emphysematous Pyelonephritis with Abscesses Masquerading as an Ordinary Urinary Tract Infection

Imran

Yick

Qavi

et al. 2015

American Journal of Infectious Diseases

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Emphysematous Pyelonephritis (EPN) is a rare, gas-forming infection of the renal parenchyma associated with significant morbidity and mortality. We report the case of a 39 year-old woman with uncontrolled diabetes who presented with abdominal pain, fevers and chills for one month. Physical exam was notable for dry oral mucosa and left costovertebral angle tenderness. Labs showed acute kidney injury and a hyperglycemic hyperosmotic state. CT abdomen revealed emphysematous pyelonephritis with a large left renal abscess. EPN should be considered in diabetic patients, especially those with uncontrolled or new-onset diabetes and those presenting with symptoms of urinary tract obstruction. Prognostic factors include thrombocytopenia, shock, altered mental status and need for hemodialysis. Our patient was treated successfully with intravenous antibiotics, percutaneous drainage, strict glucose control and monitored with serial imaging. She underwent laparoscopic nephrectomy one month later. Early diagnosis of EPN is essential as it carries a high mortality and a strong clinical suspicion is required, as patients may have an atypical presentation.

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Conservative management of emphysematous pyelonephritis

Cited by 11 publications

References 10 publications

Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment

Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment

Emphysematous pyelonephritis: a case report

Emphysematous Pyelonephritis with Abscesses Masquerading as an Ordinary Urinary Tract Infection

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