Emphysematous Pyelonephritis: Successful Management by Percutaneous Drainage

Hudson, M’Liss A.; Weyman, Philip J.; Vliet, Andrew H. van der; Catàlona, William J.

doi:10.1016/s0022-5347(17)45115-9

Cited by 70 publications

(33 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hudson et al [10] first described fluoroscopically guided PCD for treating EPN, with successful clinical results. This report was followed by many series showing the good outcomes with US-or CT-guided PCD [3,4].…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis

et al. 2010

View full text Add to dashboard Cite

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo analyse the factors predicting the mortality and need for nephrectomy in patients with emphysematous pyelonephritis (EPN).PATIENTS AND METHODSClinical features, laboratory variables, imaging studies, management strategy and the final outcomes were analysed in 39 consecutive patients with EPN. The mean (sd) age was 57 (7.2) years and the male to female ratio was 2:11. The baseline risk factors (clinical, laboratory and radiological) were compared among three groups; group 1, survived with renal salvage (26); group 2, survived after nephrectomy (eight); and group 3, died (five).RESULTSThe overall survival rate was 87% (34/39) and the kidney was salvaged in 67% (26) patients at a median follow‐up of 18 months. Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation were significantly associated with mortality rate. There was no significant difference in final outcome based on radiological classification. Extensive renal parenchymal destruction of >50% (based on computed tomography) significantly predicted the need for nephrectomy (P < 0.001) and death (P = 0.02). Early (<1 week) nephrectomy resulted in a higher mortality rate (three of seven patients) than initial conservative management. There were no deaths in selected patients who received antibiotics alone or had delayed nephrectomy (four patients each). Of 24 patients who had minimally invasive treatment alone, two (8%) died. Minimally invasive treatment resulted in high renal salvage (22/24, 92%).CONCLUSIONAltered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation are associated with higher mortality rates, whereas extensive renal parenchymal destruction is associated with a need for nephrectomy. Early nephrectomy is associated with higher mortality rates than is initial conservative management.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis

et al. 2010

View full text Add to dashboard Cite

show abstract

“…However, successful treatment of EPN using percutaneous catheter drainage (PCD) and antibiotic treatment has also been reported. [3][4][5][11][12][13][14][15] Therefore, the adequate therapeutic modalities for EPN are still controversial. Emphysematous pyelonephritis has been classified according to the location of gas accumulation because of various outcomes.…”

Section: Methodsmentioning

confidence: 99%

Emphysematous Pyelonephritis

Huang¹,

Tseng²

2000

Arch Intern Med

611

378

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6][7] Kelly and MacCullum [8] described a case of gas-forming necrotizing renal infection with pneumaturia in 1898. Multiple eponyms had been used for this gas forming infective condition such as "pneumonephritis," "renal emphysema," and "emphysematous pyelonephritis".…”

Section: Introductionmentioning

confidence: 99%

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

Sokhal¹,

Kumar²,

Purkait³

et al. 2017

Turkish Journal of Urology

View full text Add to dashboard Cite

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.

show abstract

Emphysematous Pyelonephritis: Successful Management by Percutaneous Drainage

Abstract: Emphysematous pyelonephritis is a life-threatening infection that usually requires open surgical drainage. We report a case of emphysematous pyelonephritis treated successfully with percutaneous drainage.

Cited by 70 publications

References 7 publications

Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis

Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis

Emphysematous Pyelonephritis

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

Contact Info

Product

Resources

About