Spectrum of gas within the kidney

Evanoff, George V.; Thompson, Catherine S.; Foley, Robert N.; Weinman, Edward J.

doi:10.1016/0002-9343(87)90511-0

Cited by 114 publications

(16 citation statements)

References 58 publications

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“…These include bilateral renal involvement, intrarenal abscesses, renal carbuncle and emphysematous pyelonephritis [97,101]. Indeed, some authorities recommend routine imaging of the renal tract in all diabetic patients with pyelonephritis to rule out obstruction and emphysematous and other changes [97,110]. Because of the potential for complications, UTIs should be carefully managed in diabetes.…”

Section: Urinary Tract Infectionsmentioning

confidence: 99%

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Peleg

Weerarathna

McCarthy

et al. 2006

Diabetes Metabolism Res

500

406

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SummarySpecific defects in innate and adaptive immune function have been identified in diabetic patients in a range of in vitro studies. However, the relevance of these findings to the integrated response to infection in vivo remains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hyporesponsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community-acquired infections is less well established but could be clarified if infection data from large community-based observational or intervention studies were available. The relationship between hospital-acquired infections and diabetes is well recognized, particularly among post-operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community-and hospitalacquired infections.

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Section: Urinary Tract Infectionsmentioning

confidence: 99%

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Peleg

Weerarathna

McCarthy

et al. 2006

Diabetes Metabolism Res

500

406

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“…Diabetes can also cause several changes in the host defense system, including defects in neutrophil function (14), increased bacterial adherence to the uroepithelial cells of diabetic patients (15) and decreased antibacterial activity as a result of glycosuria (16). As a result, diabetic patients tend to have a higher incidence and prevalence of bacteriuria (17), and they are at a higher risk for developing serious consequences, such as emphysematous cystitis, pyelonephritis, renal papillary necrosis, and abscess (18,19). …”

Section: Introductionmentioning

confidence: 99%

Effect of diabetes on mortality and length of hospital stay in patients with renal or perinephric abscess

Ko¹,

Chiu²,

Liu³

et al. 2013

Clinics

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OBJECTIVES:We compared the risk of in-hospital mortality and the length of hospital stay between diabetic and non-diabetic patients hospitalized for renal or perinephric abscess.METHOD:The data analyzed in this study were retrieved from Taiwan's National Health Insurance claims. The risk of in-hospital mortality and the length of hospital stay were compared between 1,715 diabetic patients, hospitalized because of renal or perinephric abscess in Taiwan between 1997 and 2007, and a random sample of 477 non-diabetes patients with renal or perinephric abscess.RESULTS:The in-hospital mortality rates from renal or perinephric abscess for the diabetic patients and the non-diabetic patients were not different, at 2.3% and 3.4%, respectively. However, diabetes was significantly associated with a longer length of hospital stay among patients with renal abscess, by 3.38 days (95% confidence interval [CI]: 1.59-5.17).CONCLUSIONS:Diabetes does not increase the risk of in-hospital mortality from renal or perinephric abscess. Nevertheless, appropriate management of patients with diabetes and concurrent renal or perinephric abscess is essential to reduce the length of hospital stay.

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“…It has also been reported in debilitated alcoholics and the severely immunocompromised [2,3] . It is characterized by accumulation of gas within the renal parenchyma, collecting system as well as perinephric tissue [4][5][6] . CT scan is mandatory not only to establish the diagnosis but also for follow-up and to decide the best line of treatment [7] .…”

Section: Introductionmentioning

confidence: 99%

Severe Emphysematous Pyelonephritis in Diabetic Patients

Abdul-Halim

Kehinde²,

Abdeen³

et al. 2005

Urol Int

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Purpose: Emphysematous pyelonephritis (EPN) is a rare, severe gas-forming infection of renal parenchyma and surrounding tissues seen mostly in diabetic patients. Diagnosis and adequate therapeutic regimen are controversial. We reviewed the clinical presentation, diagnosis and aspects of surgical management of patients presenting with severe EPN. Patients and Methods: Patients with EPN managed in our unit between 1996 and 2004 were reviewed. Diagnosis was confirmed by CT scan appearance of gas in the renal or perirenal area in a very ill patient. We compared the outcome of immediate nephrectomy with drainage of perinephric abscesses in patients presenting with severe EPN. Results: Seven patients were managed in our unit during the 8-year period. All patients were diabetic and women outnumbered men (6:1). Renogram in all 7 patients showed renal function of affected kidney to be less than 15% in 6 patients. Escherichia coli was isolated in all patients from either urine, blood or perinephric pus. Management consisted of intensive resuscitation, control of blood glucose and use of intravenous antibiotics. Emergency nephrectomy was performed in 3 patients, delayed nephrectomy after an initial period of percutaneous drainage in 2 patients, incision and drainage in one patient and immediate percutaneous drainage was performed in one patient. One patient died 5 days post-nephrectomy of myocardial infarction. Patients who had immediate nephrectomy recovered quicker (18–21 days) and had no postoperative complications. Patients who had incision and drainage, or percutaneous drainage presented with recurrent discharging sinuses or perinephric abscesses requiring further surgical interventions and spent longer time in hospital (28–37 days). Conclusion: Patients with severe EPN often present in extremis and require intensive medical treatment. The diagnosis must be entertained in diabetic women presenting with flank pain and septicemia. The function of the affected kidney is often very poor and early nephrectomy offers the best outcome. Percutaneous drainage or incision and drainage of the abscess may be performed in patients too ill for immediate formal nephrectomy.

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Spectrum of gas within the kidney

Cited by 114 publications

References 58 publications

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Effect of diabetes on mortality and length of hospital stay in patients with renal or perinephric abscess

Severe Emphysematous Pyelonephritis in Diabetic Patients

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