Abstract
Emphysematous pyelonephritis(EPN) is a potentially fatal manifestation of necrotizing infection of renal parenchymal tissues and perirenal tissues with gas formation in renal system. Its clinical significance due to its diagnostic difficulty on clinical grounds, rapid progression and the demand for the invasive management strategies in short term necessitates the need for a more vigilant approach in vulnerable population. Risk population includes female diabetic patients, obstructed infected urinary system, immunosuppression. Since its initial reporting from 19th century the treatment strategies are more towards extensive invasive approaches due to its rapid progression into fatal condition. Fortunately, with the advent of modern imaging facilities, the diagnostic difficulties were somewhat alleviated which helps in staging the disease. Thence the treatment strategy evolved over time which includes various options in treatment regime. Currently the treatment for emphysematous pyelonephritis includes resuscitation with fluid electrolyte management, intravenous antibiotics to cover gram negative bacteria, risk factor management, minimally invasive approaches towards decompression and in worst case scenario immediate or delayed nephrectomy. Here, we discuss the clinical features,aetiopathogenesis, diagnostic approaches and the treatment strategies of this uncommon but potentially fatal condition.
Highlights
Emphysematous pyelonephritis(EPN) is a potentially fatal manifestation of necrotizing infection of renal parenchymal tissues and perirenal tissues with gas formation in renal system
Its occurrence is mostly associated with the presence of diabetes mellitus(More than 80% of patients with Emphysematous Pyelonephritis’ (EPN) are diabetes) with a female preponderance (6times commoner than men) [2,3,4,5] as well
Other contributing factors are renal failure, immunosuppression, obstructed upper urinary tract and polycystic kidney disease [5,6].EPN is typically characterized by fever and flank pain with radiological evidence of gas accumulation within and around the kidney
Summary
Class 1: Gas in the collecting system only. Class 2: Gas in the renal parenchyma without extension to external space. Type 2- Gas accumulated in the collecting system of the kidney in a bubbly or loculated pattern According to this classification, patients with type EPN has more fulminant course of illness which might get worsen rapidly and high mortality rate than patients with type 2 EPN. Formed gas is entrapped due to any obstructive pathology which might coexist [11] Though this theory has been proposed as the cause for gas formation in the renal tissue, analysis of the gas content in EPN demonstrated nitrogen as the major component (60%). Another theory suggests the association of severe necrotizing infections in renal parenchyma which leads to the above condition [11]. Diabetic angiopathy has been proposed to contribute to the accumulation of gas by slowing the transport of catabolic products
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