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Emphysematous pyelonephritis

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Tags : emphysematouspyelonephritis, diabetesmellitus, escherichiacoli, percutaneousdrainage

Category : Original articles

Authors : Ahmed Haddadi, Karima Haddadi

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Emphysematous pyelonephritis (EPN) is an acute severe necrotizing renal infection with serious features.
In the absence of efficient treatement, it leads to significant morbidity and mortality due to septic complications. In the literature , it is estimated that 95% of the cases with EPN have underlying uncontrolled diabetes mellitus, and about 25–40% the risk of developing EPN secondary to a urinary tract obstruction. There are three classifications of EPN based on radiological findings. However, acute renal failure, microscopic or macroscopic haematuria, severe proteinuria are other objective positive findings in EPN. Escherichia coli is the most causative pathogen. It is found in 70% of cases with the organism isolated from urine or pus cultures. A standard KUB (Kidney-ureter- bladder) which shows an abnormal gas shadow ing the renal bed, is an alarming element, whereas anultrasound or CT scan of the abdomen will confirm EPN diagnosis. It should be noted that the gas can extend beyond the site of inflammation to the subcapsular, perineal and pararenal spaces. In some cases, it was found that the gas extended into the scrotal sac and the spermatic cord. The treatment strategies include MM alone, PCD plus MM, MM plus emergency nephrectomy, and PCD plus MM plus emergency nephrectomy. Several studies have shown patients being successfully treated with PCD when used in combination with medical management, leading to significant decrease in the morality rates. PCD should be performed on patients who have localized areas of gas. Few patients who received MM and PCD, subsequently required nephrectomy. It is important to note that nephrectomy in patients with EPN can be simple, laparoscopic or radical.!!