Emphysematous pyelonephritis – case report and review of literature
Introduction. Emphysematous pyelonephritis (EPN) is a severe, potentially fatal necrotizing infection of the kidney with the clinical picture ranging from the mild abdominal pain and discomfort to the septic shock and multiorgan failure. We presented here a case of EPN in a poorly controlled diabetic patient that was the first registered case of EPN in our clinic for more than ten years. Case report. A 78-year-old diabetic male patient was referred to the Clinic for Nephrology and Clinical Immunology of the Clinical Center of Vojvodina, Novi Sad, Serbia, with weakness, malaise, abdominal discomfort and reduced daily urine volume. After complete physical exam, laboratory work up, echosonographic and computed tomography scanning we diagnosed the patient with EPN class IV, according to the Huang and Tseng classification, with the presence of 5 risk factors for mortality (systolic blood pressure below 90 mmHg, altered consciousness, thrombocytopenia, elevated serum creatinine level, bilateral disease). Treatment with conservative therapy and percutaneous drainage was not successful, further deteorioration of the patient status ensued so the patient passed away on the 8th day of hospitalization due to the development of septic shock with multiorgan failure that was refractory to all measures that were instituted. Conclusion. EPN is a severe, potentially fatal necrotizing inflammation of the kidney and surrounding tissue. Management and prognosis of this disease depends on the clinical status, risk factors and radiological classification of the disease.
Kelly H, MacCallum WG. Pneumaturia. JAMA 2016; 31: 375−81.
Schultz EH, Klorfein EH. Emphysematous pyelonephritis. J Urol 1962; 87: 762−6.
Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicora-diological classification, management, prognosis, and patho-genesis. Arch Intern Med 2000; 160(6): 797−805.
Shokeir AA, El-Azab M, Mohsen T, El-Diasty T. Emphysema-tous pyelonephritis: a 15-year experience with 20 cases. Urolo-gy 1997; 49(3): 343−6.
Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk fac-tors for mortality in patients with emphysematous pyelone-phritis: A meta-analysis. J Urol 2007; 178(3 Pt 1): 880−5 ; quiz 1129.
Tang HJ, Li CM, Yen MY, Chen YS, Wann SR, Lin HH, et al. Clinical characteristics of emphysematous pyelonephritis. J Mi-crobiol Immunol Infect 2001; 34(2): 125−30.
Khaira A, Gupta A, Rana DS, Gupta A, Bhalla A, Khullar D. Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis. Int Urol Nephrol 2009; 41(4): 959−66.
Michaeli J, Mogle S, Perlberg S, Heiman S, Caine M. Emphysema-tous pyelonephritis. J Urol 1984; 131(2): 203−7.
Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: Correlation between imaging findings and clinical outcome. Radiology 1996; 198(2): 433−8.
Kangjam SS, Irom KS, Khumallambam IS, Sinam RS. Role of con-servative management in emphysematous pyelonephritis: A retrospective study. J Clin Diagn Res 2015; 9(11): PC09−11.
Hudson MA, Weyman P, van der Vliet AH, Catalona WJ. Emphy-sematous pyelonephritis: successful management by percuta-neous drainage. J Urol 1986; 136(4): 884−6.
Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N'Dow J; ABA-CUS Research Group. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephri-tis? Evidence from a systematic review. J Urol 2008; 179(5): 1844−9.
Kalathia J, Chipde SS, Agrawal S, Agrawal R. Nephron-sparing surgery in case of emphysematous pyelonephritis. Urol Ann 2015; 7(4): 504−6.
Kapoor R, Muruganandham K, Gulia AK, Singla M, Agrawal S, Mandhani A, et al. Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis. BJU Int 2010; 105(7): 986−9.
Evanoff GV, Thompson CS, Foley R, Weinman EJ. Spec-trum of gas within the kidney. Emphysematous pyelonephritis and emphysematous pyelitis. Am J Med 1987; 83(1): 149−54.