Emphysematous Pyelonephritis: Tertiary Care Center Experience in Management and Review of the Literature

Dhabalia, Jayesh V.; Nelivigi, Girish G; Kumar, Vikash; Gokhale, Aniruddha; Punia, Mahendra S; Pujari, Nandan

doi:10.1159/000315056

Cited by 28 publications

(42 citation statements)

References 19 publications

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“…Immediate nephrectomy may also be considered in patients in whom percutaneous drainage is deemed to be too technically difficult. It should be noted however that immediate nephrectomy is associated not only with loss of renal function but also a higher mortality than the alternatives [31]. Mortality rates vary between 10 % [32] and 40 % [14] with simple nephrectomy citing the lowest mortality figures.…”

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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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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“…1). Full reports were evaluated in 48 studies, of which 32 were included in the systematic review [1][2][3][6][7][8][10][11][12][13][14][15][16][17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Most of the studies were published within the last 10 years, reflecting the increased awareness of EPN and the associated controversy.…”

Section: Resultsmentioning

confidence: 99%

“…We compare the two classifications. As Huang classes I and II are considered mild, and classes III and IV severe, we grouped them in this way, as adopted by a few of the studies [12,16,20,21].…”

Section: Data Extraction and Analysismentioning

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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“…However, surgical intervention should be performed only after stabilization of the patient's cardiorespiratory status EPN is medical emergency, must be treated with aggressive medical management and, possibly, surgical intervention [11] to reduce mortality. Conservative treatment using percutaneous drainage with antibiotics is indicated in following conditions: [12,13]  Patients with compromised renal function.  Early cases associated with gas in the collecting system alone and patient is in otherwise in stable condition.…”

Section: Discussionmentioning

confidence: 99%