Emphysematous pyelonephritis: Changing trend of clinical spectrum, pathogenesis, management and outcome

Abstract

Objective: To highlight changing trend of clinical spectrum, comparing management options and predictors of outcome of emphysematous pyelonephritis. Material and methods:This study included patients who were diagnosed as emphysematous pyelonephritis between August, 2001 to July, 2015. We excluded other possible causes of gas in renal system. Baseline patient characteristics, clinical spectrum, serum and urinary biochemical parameters, radiological findings, management and outcomes were recorded. Patients were classified as "responders" and "non-responders". Results:We studied a total of 74 patients and categorised them as responders (62 patients) and nonresponders (12 patients). Women outnumbered men constituting 62.16% of the study population (M: F; 1: 1.6). Fever was the most common presenting symptom followed by flank pain. Diabetes mellitus (85.14%) was the most common comorbidity followed by urolithiasis (32.43%). Escherichia coli was the commonest organism grown in urine culture (79.73%). Non-responders had distinct laboratory findings relative to responders as low hemoglobin (7.8±2.1/11.2±3.2 g/dL; p= 0.0007), thrombocytopenia (91.67% vs. 11.29%; p= 0.0001), proteinuria >3 g/L (50% vs. 6.45%; p= 0.0008) and positive blood culture (100% vs. 67.74%; p= 0.0288). Conclusion:Advanced age, higher body mass index, renal impairment, thrombocytopenia, altered sensorium, shock at presentation can be used as scores for poor prognosis. Emphysematous pyelonephritis management requires multidisciplinary collaboration including hydration and electrolyte management, broad spectrum antibiotics, strict glycaemic control, effective urinary drainage and lastly it may require emergency nephrectomy as a salvage procedure.

Emphysematous Pyelonephritis Complicating an Undetected Diabetic Female: A Case Report

“…2 The therapeutic trends are in change and more conservative approach are followed now-a-days. 7 Lu Y et al have described predictors of failure in conservative management of emphysematous pyelonephritis. 8 Our patient required surgery because of class IV disease and kidney stone.…”

Case Report: Emphysematous Pyelonephritis Triggers Diabetic Ketoacidosis in a 60 Years Old Patient

“…The most commonly found cause of the disease is infection by Escherichia Coli followed by Klebsiella. EPN is considered a rare renal infection, however with increasing prevalence of diabetes, metabolic syndrome and increasing use of computed tomograms (CT), increasing number of cases are diagnosed now [2].…”

“…Emphysematous pyelonephritis is a rare and severe renal infection associated with presence of gas bubbles within the tissue of the kidney. In the onset of the disease, patients have a mild symptomatology which can progress to renal failure [2]. The most common agent responsible for this infection is E. Coli which is found in the urine cultures in almost 70% of cases, others being Klebsiella, Proteus, Pseudomonas, Clostridium species and sometimes polymicrobial infections.…”

Acute Pyelonephritis

“…Post-treatment urine cultures are recommended in all patients at the follow-up visit, one to two weeks after completion of antibiotic therapy. Complication like emphysematous pyelonephritis is usually treated with percutaneous drain or nephrectomy [11]. If recurrence of infection or relapse (reinfection less than 14 days after completing an appropriate regimen) occurs, the patient needs to undergo systematic evaluation for anatomic, functional, or structural abnormalities.…”