Emphysematous Pyelonephritis

Huang, Jing; Tseng, Chin Chung

doi:10.1001/archinte.160.6.797

Cited by 634 publications

(477 citation statements)

References 37 publications

(58 reference statements)

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“…[5] Therefore confirmation of diagnosis should be based on findings from a CT scan which is also useful for substantiating the disease. [6] Gas found on CT scan is characteristic and is produced under anaerobic conditions by gas-forming organisms mentioned above. In particular, the degree of extension of gas was reported to be an independent predictor of EPN prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the degree of extension of gas was reported to be an independent predictor of EPN prognosis. [6] Hence, percutaneous drainage and antibiotics can be a modality of treatment for patients with limited EPN while early judicious nephrectomy should be reserved for patients with extensive EPN. In the above case, although Mr K presented with an aggressive CT picture of extensive retroperitoneal gas, he responded well to percutaneous drainage and antibiotics.…”

Section: Discussionmentioning

confidence: 99%

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Emphydematous pyelonephritis - Treat the patient, not the scan

Chia

Tiong

Chien

2015

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Background: Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma. Until the late 1960s, these patients were treated with nephrectomies as EPN is associated with a high rate of mortality. It is a diagnosis based on computed tomography (CT) scan of the patient and based on the results, can be classified according to the severity of the disease. In our case report, we present a patient with seemingly extensive EPN on CT scan who was treated successfully with intravenous antibiotics (IV) and percutaneous drainage. Methods: Together with current literature, our case study adds to increasing evidence which supports how carefully selected patients can be treated with the above modalities.Results: We present a 75-year-old diabetic Indian gentleman who came to us with right iliac fossa pain and was noted to have a positive right renal punch. CT scan revealed extensive gas in the right kidney. Considering that he was clinically stable amongst other factors, he was started on appropriate IV antibiotics and underwent a percutaneous nephrostomy tube insertion. Subsequent follow-up scans showed resolution of the EPN. Conclusions: EPN is a severe, necrotizing infection of the kidneys associated with high mortality rates. As such, physicians need to have a high index of suspicion in patients who are at risk. There is increasing evidence to show that patients with early EPN can and should be treated with appropriate IV antibiotics and percutaneous drainage procedures. We hope that this will help to increase awareness of the possible treatment modalities of this potentially life-threatening disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emphydematous pyelonephritis - Treat the patient, not the scan

Chia

Tiong

Chien

2015

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“…In essence all of these classifications are reliant on CT scan results which depict the extent of gas formation [4] [5], and the early response to conservative therapy. Only one such classification exists which addresses EPN in renal allografts [6].…”

Section: Discussionmentioning

confidence: 99%

Emphysematous Pyelonephritis in a Renal Transplant Patient

Piracha¹,

Darras²,

Nord³

et al. 2014

OJNeph

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Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection of the kidney that is caused by gas-forming organisms. We report a case of a 58-year-old man with a renal transplant who presented to the emergency room with nausea, vomiting and right lower quadrant abdominal pain. At the time of presentation, he was hemodynamically stable, and the abdominal examination was significant for tenderness over the allograft. Urinalysis was positive for large amounts of leukocyte esterase and white blood cells. He received empiric antibiotic coverage with piperacillin/tazobactam. Over the following 24 hours, the patient developed septic shock manifested by hemodynamic instability. A non-contrast CT scan of the abdomen and pelvis elucidated a heterogeneous gas containing collection in the allograft. Emergent transplant nephrectomy was performed. Postoperatively, the patient rapidly recovered and was subsequently discharged home to commence outpatient hemodialysis. A review of the literature suggests that early recognition of the severity of EPN as manifested by hemodynamic instability dictates emergent transplant nephrectomy as the treatment of choice.

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“…Based on CT scan findings, emphysematous pyelonephritis can be categorized into four prognostic classes: class 1: gas in the collecting system only; class 2: gas in the renal parenchyma without extension to extrarenal space; class 3A: extension of gas to perinephric space; class 3B: extension to pararenal space; and class 4: solitary kidney with this condition or bilateral involvement 2. Milder cases (class 1 and 2) can be treated with percutaneous catheter drainage and antibiotic therapy, while severe cases may need nephrectomy as in ours (class 3B).…”

Section: Case Descriptionmentioning

confidence: 99%