Abstract
Emphysematous pyelonephritis (EPN) is a rare, severe acute, necrotizing infection of the kidney characterized by presence of gas within the renal parenchyma, collecting system and perirenal tissues. It is commonly caused by ascending infection due to E.coli. Other gas forming organisms like Klebseilla, proteus etc. may spread by hematogenous route. A patient especially if a woman, with poorly managed diabetes, presents with urinary tract infection, sepsis and renal insufficiency. Ultrasound and CT plays an invaluable role in the diagnosis and management. In our study, nine patients of EPN were studied during the period of 2011-2013. All the patients were diabetics, invariably presented with fever, abdominal discomfort or pain at the time of presentation. Pus in urine with raised TLC with leukocytosis was seen in all of them. Urine culture showed bacterial growth in 5(55.5%) patients, with E. coli, the commonest organism. All patients had hyperglycemia with mean blood sugar level was 354mg/dl. Serum creatinine was raised with mean level of 3.7mg/dl suggesting renal dysfunction. The male to female ratio was 1:3.5 with age range of 42-65 years. Radiological investigations like plain X ray, Ultrasound and Computed tomography of abdomen showed pockets of air in the renal regions in all 9(100%)patients, bilateral in two(22.3%) and unilateral in 7(77.7%) patients. Mild hydronephrosis was seen in 1(11%) patient. Perinephric extension of gas with perinephric collection was noted in 4(44.5%) patients. After clinicoradiological investigations the diagnosis of EPN was made with 2(22.3%) cases of Type I EPN and 7(77.7%) cases of Type II EPN.DOI: http://dx.doi.org/10.3126/njr.v4i1.11368 Nepalese Journal of Radiology, Vol.4(1) 2014: 38-46
Highlights
NJR I VOL 4 I No 1 I ISSUE 6 I Jan-June, 2014Singh A
The renal parenchymal gas on ultrasound appear as areas of echogenic foci with posterior „dirty‟ shadowing or ringing down artifacts due to air, in a non-dependent position which may change with patient posture (Fig1a,2b)
During the period 2011-2013, eight patients with gas producing renal parenchymal infection that met the criteria of clinical manifestations of fever, local pain or tenderness in loin region, pyuria and imaging findings of gas in renal parenchyma, collecting system or perirenal space
Summary
NJR I VOL 4 I No 1 I ISSUE 6 I Jan-June, 2014Singh A. Clinico-radiological Features and Classification of Emphysematous Pyelonephritis: A prospective study treatment of causative factors reduces high degree of morbidity and mortality.[1]. The conventional X ray examination shows “mottled” appearance due to air pockets in the renal fossa or perirenal gas collections within the Gerota fascia (Fig.2a, 4a). The renal parenchymal gas on ultrasound appear as areas of echogenic foci with posterior „dirty‟ shadowing or ringing down artifacts due to air, in a non-dependent position which may change with patient posture (Fig1a,2b). Such echogenic foci should be differentiated from renal stones, which are mostly echogenic in nature have posterior acoustic shadowing which have clean margins. Gas may be present inside the collecting system in emphysematous pyelitis.[2]
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