Emphysematous Pyelonephritis: Our Institutional Experience

Abstract

Emphysematous pyelonephritis (EPN) is a rare acute necrotizing infection of renal parenchyma. We discuss clinical details and treatment strategies of 28 patients with EPN followed at our hospital. EPN is common in persons with diabetes, often has a fulminating course and can be fatal if not recognized and treated promptly. Its overall mortality rate ranges between 19% and 43%. METHODS: We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 18 patients with EPN followed at our hospital between 2012 and 2014. RESULTS: The mean patient age (Female: 12; male: 6) was 65 years (Range: 51-82). Based on computed tomographic findings, EPN was classified as class I (n=3), class II (n=6), class IIIA (n=5), class IIIB (n=3) and class 1V (n=1). All patients had fever, flank pain, nausea, and vomiting. Sixteen patients had type 2 diabetes mellitus and 4 diabetic patients also had renal stones. Escherichia coli (n=14), Klebsiella species (n=3), and mixed species (n=1) were grown in urine cultures. Seventeen patients had unilateral involvement. Increased white blood cell counts, sedimentation rate, and C-reactive protein levels were detected in all cases. In addition to medical treatment, 5 patients underwent a nephrostomy catheter placement and a total of 3 patients underwent nephrectomy upon deterioration. After achieving clinical stabilisation with medical treatment, 7 patients underwent endoscopic ureteral stone treatment. The remaining 3 cases were treated only with antibiotics. One patient died even after nephrostomy and antibiotic therapy and seventeen patients were discharged with clinical cure. CONCLUSION: Mortality rates of EPN are gradually decreasing. Preservation of renal reserve is possible due to early diagnosis, appropriate antibiotic therapy, and drainage.