Importance of surgical intervention in emphysematous pyelonephritis: A case report

Abstract

Emphysematous pyelonephritis (EPN) is a rare necrotizing infection characterized by gas formation within or around the renal parenchyma. Clinical presentations include fever, abdominal pain, vomiting, septic shock, altered sensorium, and acute kidney injury. Uncontrolled diabetes and urinary tract obstruction are the most common risk factors, especially in women. Escherichia coli and Klebsiella Pneumoniae are frequently involved pathogens. The diagnosis is usually based upon computed tomography that shows gas patterns in renal parenchyma. Treatment modalities include conservative management with broad-spectrum antibiotics, glycemic control, prompt fluid resuscitation, and surgical intervention such as percutaneous drainage, double J stenting, and nephrectomy. The objective of this case report is to present a 72-year-old female patient with uncontrolled type-2 diabetes and recurrent urinary tract infection who was hospitalized with complaints of altered sensorium, hypoglycemia, hyperpyrexia, excessive vomiting, abdominal pain, and severe sepsis. The diagnosis was based upon computed tomography scan that showed an enlarged left kidney with gas patterns in the renal parenchyma, confirming emphysematous pyelonephritis. Surgical intervention was suggested by the urologist; instead conservative management was employed for the patient due to financial burden. The expected outcome was not achieved with conservative approach and the importance of surgical intervention was observed.