Renal salvage, an achievable goal in patients with emphysematous pyelonephritis: Outcomes of an algorithmic renal preserving strategy

Adapala, Rajeshkumar Reddy; Shetty, Raviraj; Venugopal, P; Prabhu, Girish; Durgarao, Yalla; Unnikrishnan, Bhaskaran

doi:10.4103/ua.ua_67_19

Cited by 9 publications

(18 citation statements)

References 28 publications

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“…Many reviews suggest clinical response as the trigger for emergent nephrectomy. 4 One algorithm by Adapala et al suggests repeat imaging after three days, 5 which would have been too late in our patient's case.…”

Section: Discussionmentioning

confidence: 85%

Case report: Bilateral emphysematous pyelonephritis with pneumatosis intestinalis

D'Amico

Izes

Das

2022

Urology Case Reports

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Emphysematous pyelonephritis is a severe and rare gas producing infection in the renal parenchyma or collecting system. Diabetes mellitus is an established risk factor. Treatment options include antibiotics, minimally invasive management such as percutaneous drainage, or nephrectomy. This case report describes a 40-year-old female with newly diagnosed diabetes and cirrhosis who presented with left sided emphysematous pyelonephritis. After initial management with intravenous antibiotics and drainage of the collecting system, this patient's clinical condition worsened, and subsequent repeat imaging revealed bilateral emphysematous pyelonephritis as well as pneumatosis intestinalis.

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Section: Discussionmentioning

confidence: 85%

Case report: Bilateral emphysematous pyelonephritis with pneumatosis intestinalis

D'Amico

Izes

Das

2022

Urology Case Reports

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“…The incidence is higher in females than males, with a preponderance (3:1) and mean age of 56.6 years. Diabetes mellitus (DM) constituted the most commonly associated comorbidity and a risk factor for EPN, with an incidence of 85% [4,6,7]. Other comorbidities include urolithiasis, a previous history of treated pyelonephritis, and chronic kidney disease [6].…”

Section: Epidemiologymentioning

confidence: 99%

“…Risk factors for pediatric: neurogenic bladder, ureteropelvic junction obstruction, obstruction due to ectopic ureter, renal stone, nephro-urological congenital malformation, congenital ureterocele, and acquired immunodeficiency [8]. The left kidney is most commonly affected in 52-67%, on the right side in 25-37.7%, and bilateral in 10.2-15.3% [4,6,7,9].…”

Section: Epidemiologymentioning

confidence: 99%

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Emphysematous Urinary Tract Infections

Avalos¹

2023

Urinary Tract Infections - New Insights

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Emphysematous urinary tract infections are severe necrotizing infections of the urinary tract. The descriptive term emphysematous is used for the gas location site: pyelonephritis, pyelitis, and cystitis. Most cases occur in adult females. Diabetes mellitus constitutes the most commonly associated comorbidity and a risk factor for necrotizing infections. Pathogenesis still needs to be fully understood. Escherichia coli is the most common microorganism, followed by Klebsiella pneumonia, Proteus mirabilis, and Pseudomonas aeruginosa. Bacteremia occurs in more than half of cases. The treatment includes resuscitation, glycemic control, and antimicrobial therapy, followed by early drainage. Emphysematous cystitis is the most common and frequently least morbid gas-forming urinary tract infection. Using minimally invasive image-guided procedures for drainage of gas and abscess is a conservative strategy with renal preservation, while emergency nephrectomy is considered the last option. Mortality rates have a direct correlation between the computed tomography findings and the modalities of treatment.

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“…[ 8 ] With the adoption of minimally invasive renal drainage, nephrectomy was reserved only for the patients with progressive disease or those deemed to be having refractory sepsis inspite of initial renal salvaging measures. [ 9 ]…”

mentioning

confidence: 99%

Is there still a role of nephrectomy in management of emphysematous pyelonephritis in today's era?

Shah

2021

Journal of Postgraduate Medicine

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Renal salvage, an achievable goal in patients with emphysematous pyelonephritis: Outcomes of an algorithmic renal preserving strategy

Cited by 9 publications

References 28 publications

Case report: Bilateral emphysematous pyelonephritis with pneumatosis intestinalis

Case report: Bilateral emphysematous pyelonephritis with pneumatosis intestinalis

Emphysematous Urinary Tract Infections

Is there still a role of nephrectomy in management of emphysematous pyelonephritis in today's era?

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