Emphysematous pyelonephritis: A single center study

Abstract

We present our experience of 22 cases of emphysematous pyelonephritis (EPN) treated from 1996 to 2012. Medical records were analyzed retrospectively for demographic profile, presence and duration of diabetes mellitus, and mode of clinical presentation. EPN was diagnosed based on demonstration of intra-renal gas by plain X-ray, ultrasound, and/or computed tomography (CT) scan. Details of medical treatment, reason for surgical intervention, and final outcome were recorded. Univariate analysis was performed to identify risk factors for mortality and P value of less than 0.05 was taken as significant. Twenty-two cases (6 males, 16 females) of EPN were diagnosed. Seven cases presented with acute pyelonephritis, seven cases with urosepsis, and the remaining eight patients with multi-organ dysfunction. CT grading of EPN was class IV in three, class III in four, class II in 14, and class I in one. All were initially managed medically with parenteral antibiotics. Ten patients needed additional surgical intervention. The overall survival rate was 86.3% (19/22). Among the risk factors analyzed higher CT grade, altered sensorium and thrombocytopenia were significantly associated with mortality. We conclude that a more conservative approach in managing EPN has become the standard of care. Patients having high CT grade of lesions (III and IV) with altered sensorium and thrombocytopenia at presentation are more likely to die due to the disease and may be better managed by an aggressive surgical plan.

Emphysematous Pyelonephritis Following Ureterovesical Reimplantation for Congenital Obstructive Megaureter. Pediatric Case Report and Review of the Literature

“…The pathogenesis of EPN is still unknown. Several key factors have been proposed including the presence of gas-forming bacteria, high levels of glucose in the tissues, impaired tissue perfusion, reduced host immunity and urinary tract obstruction (5, 18). About 90% of adult cases have been reported in diabetics, especially in females (2).…”

“…About 90% of adult cases have been reported in diabetics, especially in females (2). Therefore, it is thought that hyperglycaemia which results in renal vasculopathy, renal neuropathy, and leukocyte dysfunction (5, 18) is a major predisposing factor for EPN; obstructive uropathy has been another contributing factor in other cases. In the pediatric population (6–11), no children with diabetes have been described.…”

Clinical profile and successful outcomes of conservative and minimally invasive treatment of emphysematous pyelonephritis

“…Female patients (59%) outnumbered male (41) patients because of their increased susceptibility to urinary tract infections [ 16 ]. E. coli (82%) and Klebsiella species (12%) are the most common organisms [ 17 ]. In our study, E. coli was seen in 39% patients.…”

A Case Series of Emphysematous Pyelonephritis

“…Due to advances in medical imaging, interventional radiology, newer more effective antibiotic therapy, and readily available intensive care integrated with dialytic support, patients with EPN have much better outcomes. Managing EPN more conservatively has thus become the standard of care [ 15 ]. Our approach to patient management is in accordance with current evidence based protocols.…”