History and physical examination are the most useful tools for diagnosis. A 67yearold woman with diabetes and poor glycemic control who had recently been treated for pyelonephritis presented to the emergency department in. Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Other risk factors include urinary tract obstruction and immunocompromise. Emphysematous pyelonephritis epn is a rare, severe, acute, necrotizing infection of the kidney. Emphysematous pyelonephritis epn is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. It is a lifethreatening condition with a high mortality rate. Emphysematous pyelonephritis is a rare but life threatening infection of kidney that is characterized by gas formation within or around the kidney. The clinical course of epn can be severe and lifethreatening if not recognized and treated promptly. Pyelonephritis is an upper urinary tract infection involving the kidneys with an incidence in the usa as high as. Advanced renal failure is rare in the absence of coexisting urinary tract obstruction. Prediction of acute pyelonephritis from urinary tract infection in. The tests used to diagnose pyelonephritis depend on the patients age, gender, and response to treatment and include the following.
Our experience with conservative management in 14 cases pramod kumar sharma, ritu sharma1, mukesh k. Pyelonephritis is a pyogenic infection of renal parenchyma that involves the renal pelvis. History and physical examination are the most useful tools for. Acute pyelonephritis apn is a serious form of urinary tract infection uti.
The term pyelonephritis denotes inflammation of the renal pelvis and kidney. Current management of emphysematous pyelonephritis. The present case report aims to describe two different manifestations of this infection. Emphysematous pyelonephritis refers to a morbid infection with particular gas formation within or around the kidneys. After a fast diagnostic procedure, immediate hemodialysis in uremia and bilateral nephrectomy let the patient survive in a stable clinical condition dependent on regular dialysis treatment.
It predominantly affects female diabetics and can occur in patients with type i and type ii diabetes. Emphysematous pyelonephritis epn is a rare and severe form of acute pyelonephritis. The patient had visited her primary care physician 1 week before a water pill refill and general medical examination. Such localization is usually inferred clinically from the presence of. Emphysematous pyelonephritis is a gasproducing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue. Urinary tract infection and asymptomatic bacteriuria guidance. Pdf pyelonephritis is an upper urinary tract infection involving the kidneys with an incidence in the usa as high as 250. Emphysematous pyelonephritis in a diabetic patient with.
Populationbased epidemiologic analysis of acute pyelonephritis pdf. He was diagnosed with emphysematous pyelonephritis, and was successfully treated in our. Emphysematous pyelonephritis epn is an uncommon infection characterized by gas in the renal parenchyma and surrounding tissues. This condition is primarily encountered in patients with diabetes mellitus or ureteral obstruction, and is characterized by the production of intrarenal and perinephric gas. Emphysematous pyelonephritis a case series from a single. Recurrent pyelonephritis require, particular in children, the exclusion or diagnosis of vesicoureteral reflux. The disease is encountered mainly in patients with diabetes mellitus and is characterized by the production of intrarenal and, occasionally, perirenal gas. Clinical characteristics of emphysematous pyelonephritis. Emphysematous pyelonephritis in a diabetic leading to.
Emphysematous pyelonephritis epn is a rare condition which is potentially life threatening. It is rapidly progressive, requiring appropriate therapy to salvage the infected kidney. Case series, report by canadian urological association journal cuaj. Diagnosis and management of acute pyelonephritis in adults. Its annual incidence is 250,000 cases in the us and the incidence of hospitalized apn is 11. Introduction this selfassessment module on the imaging evaluation of emphysematous pyelonephritis has an educational component and a selfassessment component. However the prevalence may be higher in the indian subcontinent. Management of this condition has traditionally been aggressive and surgery is considered mandatory. However, this is itself a hazardous intervention in a septic, unstable patient with circulatory or liver failure. Risk factors for symptomatic urinary tract infection in women with diabetes. Pyelonephritis occurs as a complication of an ascending urinary tract infection uti which spreads from the bladder to the kidneys and their. Bilateral emphysematous pyelonephritis is a life threatening condition usually occurring in diabetics. The example of a 55yearold diabetic man with bilateral emphysematous pyelonephritis demonstrates the diagnostic and therapeutic possibilities. A kidney infection is called a pyelonephritis and is usually more severe than a bladder infection.
It is usually caused by the bacterium escherichia coli e coli. Infection in the kidneys may spread to the bloodstreama serious condition called sepsisthough this is also uncommon. Emphysematous and xanthogranulomatous pyelonephritis. It is characterised by gas formation within the collecting system, renal parenchyma andor perirenal tissues. Treatment of a case of emphysematous pyelonephritis that. In diabetics, who are the ones at risk for this condition, leukocytosis and. A 58yearold woman with a past medical history of hypertension and arthritis presented to the emergency department of the massachusetts general hospital complaining of 1 week of progressive fatigue. Emphysematous pyelonephritis in a diabetic leading to renal destruction. In this study, we present the clinical details, the management.
Prognosis in this type is much better 18% mortality parenchymal destruction absent. Diagnosis and treatment of acute pyelonephritis in women. If not treated early, it may lead to fulminant sepsis and, therefore, carries a high mortality. Emphysematous pyelonephritis is a rare, lifeendangering suppurative infection of the renal parenchyma and perirenal tissues. The recommendations in this guideline represent the view of nice, arrived at after careful consideration of the evidence available. Emphysematous pyelonephritis is associated with a high degree of morbidity. Acute pyelonephritis is a common bacterial infection of the renal pelvis and kidney most often seen in young adult women. The educational objectives for this selfassessment module are for the participant to exercise, selfassess, and improve his or her understanding of the role of imaging in the diagnosis of emphysematous pyelonephritis and the impact of ct findings on the management of emphysematous pyelonephritis. Most of the information has been from case reports, a few large series have also been reported. Emphysematous pyelonephritis epn is a severe, necrotizing infection of the renal parenchyma. Compare and contrast methods to diagnose urinary tract infection and pyelonephritis in children. Emphysematous pyelonephritis a case series from a single centre in southern india published. The reported prevalence in western countries is still low at 12 cases year in urology practices. We report on a case of a 55 year old caucasian male with no prior medical history presented with left flank pain and malaise.
Emphysematous pyelonephritis is a severe, necrotizing, renal parenchymal infection that is characterized by the production of intraparenchymal gas. Creactive protein crp is usually used to assess the degree of disease and the therapeutic effect by mea suring serum crp level. Kundu department of urology, institute of post graduate medical education and research, sskm hospital, 1department of obstetrics and gynecology, nrs medical college, kolkata. Emphysematous pyelonephritis epn is a severe, acute necrotizing infection with formation of gas in the collecting system, renal parenchyma and perirenal tissues. Gas in the renal pelvis alone, without parenchymal gas, is often referred to as emphysematous pyelitis. Emphysematous pyelonephritis epn is a severe necrotizing infection of the renal parenchyma. Pyelonephritis chronic associated with kinking of ureter pyelonephritis chronic associated with obstruction of ureter pyelonephritis chronic associated with stricture of pelviureteric junction. It is usually lifethreatening and should be promptly treated. Emphysematous pyelonephritis epn is a rare but potentially lifethreatening necrotizing renal parenchymal infection characterized by the production of intraparenchymal gas.
The vast majority occur in those with diabetes mellitus andor urolithiasis in this case it is present bilaterally and on the right has perforated the renal capsule to extend in the most profound fashion into the retroperitoneum. The radiological classification and adequate therapeutic regimen are controversial and the prognostic factors and pathogenesis remain uncertain. The case series presents 5 patients with a clinical and radiologic diagnosis of epn. Emphysematous pyelonephritis risks, symptoms and leading. Conventional radiography reveals the renal emphysema in 85% of the cases. We report a case of diabetes mellitus that presented to the emergency department with abdominal pain, decreased urine output and altered mental status and was diagnosed as emphysematous pyelonephritis with severe urosepsis. The patient usually presents with fevers and flank pain. Acute bilateral emphysematous pyelonephritis successfully. Learn about emphysematous pyelonephritis from patients first hand experiences and trusted online health resources, including common treatments and medications. Emphysematous pyelonephritis is a severe, lifethreatening infection of the renal parenchyma and perinephric tissues. Diabetes is the single most common risk factor for the development of epn. These distinct clinical entities vary in clinical course, management, and prognosis. Treatment duration for pyelonephritis and complicated uti.