Emphysematous Pyelonephritis: Case Series and Review of the Literature

Abstract

Introduction: Emphysematous pyelonephritis (EPN) is a rare gas-forming infection of renal parenchyma and excretory system and surrounding renal areas. It has a low incidence but high mortality (15-20%). Objectives: Our goal is to report our series of EPN and review the literature about this entity to improve its management. Materials and Methods: We analyze three EPN cases, in our Centre from 2017 to 2019, two women and one man between 45-84-years-old. Common symptoms were pain and fever with fatal evolution to septic shock in one of them. Medical management was adopted in all of them. Percutaneous nephrostomy was needed in two cases to complete treatment. And one case of dry type EPN required an urgent nephrectomy. Escherichia coli was isolated in all cases. Mortality rate reached 33.3%. Discussion and Conclusion: EPN is a rare and severe necrotizing infection of renal parenchyma and its surrounding areas. It appears most commonly in females (6: 1). Diabetes mellitus is the main risk factor and urinary obstruction occurs in 25- 40%. Escherichia coli is isolated in 70%. There are many classifications to establish the best treatment according to stage. The most complete is Huang and Tseng classification (2000), based on CT radiological findings. Systolic pressure <90 mmHg, thrombocytopenia, bilateral EPN are associated with poor prognosis. Early medical treatment is essential. The most accepted management consist of support measures with percutaneous nephrostomy. In not-responding patients and those with bad prognosis, urgent nephrectomy can be necessary.