Emphysematous infections of the kidney and urinary tract: A single-center experience

Abstract

Emphysematous pyelonephritis (EPN) is a group of potentially life-threatening conditions seen particularly in diabetics, leading to high morbidity and mortality. Our aim was to study the profile of emphysematous infections of the kidney and urinary tract and evaluate the effect of early surgical intervention on mortality. This is an observational study conducted in a tertiary care hospital between January 2009 and January 2013, in which the clinical, laboratory, microbiological and radiological profiles of patients with EPN (diagnosed based on clinical, laboratory and imaging findings) was studied. A total of 12 patients were studied, including 10 with diabetes. A total of 66.6% had pyelonephritis, 25% had both cystitis and pyelonephritis and 8.3% had only cystitis; involvement of the left kidney was more common and bilateral involvement was seen in two cases. The clinical features seen in the patients included fever (100%), features of urinary infection (66.6%) and flank pain (50%). Culture positivity was seen in only 50% of the cases. Ten patients underwent percutaneous drainage (PCD) within 24 h, and two of these patients required nephrectomy subsequently. All patients were followed-up for one month. There was one death (mortality 8.3%), and all other patients responded well and recovered. Our study suggests that EPN is a potentially life-threatening condition that requires aggressive and prompt medical therapy with early PCD to reduce morbidity and mortality. Nephrectomy should be reserved for cases that do not respond to PCD.

Emphysematous pyelonephritis: Is nephrectomy warranted?

“…In contrast, other studies suggested that PCD is a quite effective and adequate approach with a high success rate even in extensive EPN. [ 3 4 11 12 13 14 15 16 22 23 ] which is in accordance with our study where patients managed conservatively had a good outcome and survived. Furthermore, two patients with class I and class IV treated primarily with DJ stent showed improvement similar to those treated with nephrostomy.…”

“…In contrast to other study, which showed that dysuria is the most common complaint. [ 2 ] Although EPN involves the left kidney more frequently than the right,[ 11 ] in our study, it involved the right and left kidney equally, with two cases showing bilateral involvement.…”

“…Despite the morbidity and mortality of EPN [ 5 7 8 ] there is still conflicting reports regarding the most appropriate management. [ 1 3 4 6 9 10 11 12 13 14 15 16 17 18 ] Early interference with nephrectomy was almost a mandatory approach due to increased mortality with medical therapy favoring interventional approach, leaving PCD for inoperable cases. [ 1 6 9 10 17 18 ] This approach has been changed recently due to early detection of patients with EPN with the aid of advanced radiological modalities, alongside early management with potent antibiotics, reserving nephrectomy for patients refractory to conservative measures.…”

Emphysematous Pyelonephritis: a Review of a Rare Condition

“…According to Huang et al, disturbance of consciousness, shock on presentation, thrombocytopenia and acute renal insufficiency are all risk factors associated with an increased mortality [2]. Polymicrobial infections and inappropriate empirical antibiotics were also associated with mortality risk [6], as are EPN type 1 and bilateral EPN [16]. A study of 41 patients cited that those with just one risk factor have a 27 % risk of mortality, compared to 100 % in those with three [17].…”

“…Clinical suspicion should be heightened in those with predisposing risk factors including diabetes mellitus, urinary tract obstruction (e.g. ureteric calculi), immune-compromise, alcohol and substance abuse and patients with neuropathic bladders [6]. Of these, diabetes mellitus and urinary tract obstruction are the most common aetiological factors, identified in up to 90 and 50 % of patients, respectively [7•].…”