Emphysematous pyelonephritis: fatal outcome during percutaneous drainage

Abstract

Emphysematous pyelonephritis (EPN) has been defined as an acute, severe, necrotizing infection of the renal parenchyma and perirenal tissue, which results in the presence of gas within the renal parenchyma, collecting system, or perinephric tissue [1, 2]. This clinical entity is highly associated with insulin dependent diabetes mellitus and usually seen in females [1–3]. Eschericia coli is the most commonly reported organism but Proteus, Pseudomonas, Klebsiella and mixed bacterial flora have also been implicated. Although plain radiography and ultrasonography can be diagnostic, computed tomography by allowing optimal detection and delineation of the extent of the emphysematous process, is accepted as gold standard examination in EPN. Mortality rates for EPN although declining in recent reports are between 7–78% depending on the applied therapeutic modality [1, 2]. Medical treatment alone carries the highest mortality risk while the approach consisting of early nephrectomy and/or surgical drainage combined with broad spectrum antibiotics reported to have the lowest [2, 4, 5]. In addition to this approach, recent advent of interventional radiological procedures has allowed successful treatment of EPN using a percutaneous drainage (PD) procedure [3, 5, 6]. This technique is advocated and usually performed in the critically ill high risk patient group. We report a case with right sided EPN in whom the percutaneous drainage attempt resulted in fatality.