Emphysematous pyelonephritis: fatal outcome during percutaneous drainage

Akpek, Sergin; Turgut, Tayfun; Özdemi̇r, Hakan; Ilgıt, Erhan; Işık, Sedat

doi:10.1016/s0720-048x(97)01177-7

Cited by 10 publications

(6 citation statements)

References 17 publications

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“…Thrombocytopenia, one of the poor prognostic factors, was observed, and PCD or nephrectomy was indicated immediately if the patient's general condition had stabilized [12]. However, our patient was an elderly diabetic patient on HD to have high risk of developing serious complications after nephrectomy or PCD [13]. For those reasons, he and his family members refused the invasive procedures.…”

Section: Discussionmentioning

confidence: 99%

Successful management of bilateral emphysematous pyelonephritis with abscess formation in a chronic hemodialysis patient: a case report

et al. 2014

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Bilateral emphysematous pyelonephritis (EPN) has seldom been reported in patients on maintenance hemodialysis (HD). Percutaneous catheter drainage (PCD) or nephrectomy is often required in the treatment of bilateral EPN because of its poor response to antimicrobial agents and high mortality rate. We report a patient with bilateral EPN on maintenance HD. An octogenarian man with diabetes mellitus who had previously undergone regular HD for 22 months was admitted to our hospital because of severe inflammation resulting from bilateral EPN. His lesions of EPN had resulted in abscess formation in both kidneys and right and left side retroperitoneal space. As patient refused interventional therapy including nephrectomy or PCD, he was treated conservatively. After treatment with several antimicrobial agents for 50 days, he completely recovered from bilateral EPN. To our knowledge, this is the first case report of successful conservative management (antimicrobial therapy alone) of bilateral EPN that developed in a chronic diabetic HD patient.

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Section: Discussionmentioning

confidence: 99%

Successful management of bilateral emphysematous pyelonephritis with abscess formation in a chronic hemodialysis patient: a case report

et al. 2014

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“…Previously open drainage of abscess had been used, but these have been largely superseded by modern advancements. Success rates are variable, ranging between 18 to 80 % in one series [29]. Mortality resulting from failure of drainage is high, however, with one study citing a failure rate of 11 of 19, with 5 of those 11 patients subsequently dying [29].…”

Section: Managementmentioning

confidence: 99%

Emphysematous Pyelonephritis: a Review of a Rare Condition

Mahesan

Reddy

Chetwood

et al. 2015

Curr Bladder Dysfunct Rep

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Emphysematous pyelonephritis (EPN) is a rare condition which is potentially life threatening. It is characterised by gas formation within the collecting system, renal parenchyma and/or perirenal tissues. Diabetes is the single most common risk factor for the development of EPN. Other risk factors include urinary tract obstruction and immunocompromise. Escherichia Coli is the most common pathogen. EPN is characterised by fever, loin pain and systemic upset. Gold standard diagnosis and classification of EPN is made with contrast CT. Classification can be used as a prognostic indicator for mortality and to guide management. EPN may be managed conservatively or surgically. Patients managed conservatively are resuscitated and administered with intravenous antibiotics. Intravenous fluid, glucose control for diabetics and acid base balance are vital components for primary management. For those in whom conservative management is unsuccessful, a parenchymal drain may be considered to drain gas or a collection of pus. Patients with hydronephrosis will benefit from a nephrostomy or JJ stent insertion. Patients who have failed minimally invasive surgical intervention or who have a number of risk factors predisposing them to EPN should undergo either immediate or delayed nephrectomy. With treatment for EPN now moving away from nephrectomy towards less invasive interventions, mortality rates for EPN are improving but remaining high.

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“…Most of the studies were published within the last 10 years, reflecting the increased awareness of EPN and the associated controversy. After reading the full reports, 16 studies were excluded for various reasons [4,5,9,[38][39][40][41][42][43][44][45][46][47][48][49][50]; eight were case reports [9,38,40,43,44,46,47,49], while five others were excluded as they were reporting on emphysematous cystitis [41,42,45,48,50], and two were excluded as they were systematic reviews [5,39]. The final excluded study, Wan et al [4] was excluded, as they reported an updated version of their data, which were included in this review [14].…”

Section: Resultsmentioning

confidence: 99%

670 Emphysematous pyelonephritis: Time for a management plan with an evidence based approach

Aboumarzouk¹,

Zreik²,

Hughes³

et al. 2014

European Urology Supplements

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Introduction: Emphysematous pyelonephritis (EPN) is a life-threatening necrotising kidney infection, but there is no consensus on the best management.Methods: We systematically reviewed previous articles published from 1980 to 2013 that included studies reporting on EPN, and applying the Cochrane guidelines, we conducted a meta-analysis of the results.Results: In all, 32 studies were included, with results for 628 patients (mean age 56.6 years, range 33.8-79.9). There were 462 women, outnumbering men by 3:1. Diabetes was present in 85% of the cases. Fevers and rigor (74.7%), pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was associated with 54.4% of deaths while obstructive uropathy was associated with 15.1% of deaths. Computed tomography was diagnostic in all the cases. Percutaneous drainage (PCD) and medical management (MM) alone were associated with a significantly lower mortality rate than was emergency nephrectomy (EN), with an odds ratio (95% confidence interval) for PCD vs. EN of 3.13 (1.89-5.16; P < 0.001), for EN vs. MM of 2.84 (1.62-4.99; P = 0.001), and of 0.91 (0.53-1.56; P = 0.73, i.e., no difference) for * Corresponding author. Tel.: +44 7886885677. E-mail address: aboumarzouk@gmail.com (O.M. Aboumarzouk). Peer review under responsibility of Arab Association of Urology. Production and hosting by ElsevierArab Journal of Urology (2014) PCD vs. MM. Open drainage also had a significantly lower mortality rate than EN, with a ratio of 0.12 (0.02-0.91; P < 0.04).Conclusion: The overall mortality rate was %18%; shock was associated with a high mortality rate and therefore should be managed aggressively. PCD and MM were associated with significantly higher survival rates than EN, and therefore EN should only be considered if the patient does not improve despite other treatments. ª 2013 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology.

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Emphysematous pyelonephritis: fatal outcome during percutaneous drainage

Cited by 10 publications

References 17 publications

Successful management of bilateral emphysematous pyelonephritis with abscess formation in a chronic hemodialysis patient: a case report

Successful management of bilateral emphysematous pyelonephritis with abscess formation in a chronic hemodialysis patient: a case report

Emphysematous Pyelonephritis: a Review of a Rare Condition

670 Emphysematous pyelonephritis: Time for a management plan with an evidence based approach

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