Reply by the Authors

Abstract

As pointed out by Dr. Turunc, emphysematous pyelonephritis (EPN) is a life-threatening condition characterized by the presence of gas in renal parenchyma, collecting systems, and/or adjacent tissues. A timely diagnosis and adequate identification of prognostic factors are crucial to decision-making process and selection of optimal treatment. Unfortunately, in our opinion, radiographic appearance is not as accurate as needed to determine the prognosis of a patient with EPN. Recently, our group published a multicenter series of 62 patients with EPN. 1 Olvera-Posada D. Armengod-Fischer G. Vazquez-Lavista L. et al. Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico. Urology. 2014; 83: 1280-1284 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Surprisingly, we found that there was no difference in mortality rates when comparing Huang's classification 2 Huang J.J. Tseng C.C. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000; 160: 797-805 Crossref PubMed Scopus (508) Google Scholar categories (P = .55). Instead, a thorough clinical workup supported by radiographic evaluation is recommended. Previously, we have demonstrated that impaired consciousness, multiple organ failure, hyperglycemia, and elevated leukocyte count are independent predictors of poor outcome. 3 Olvera-Posada D. Garcia-Mora A. Culebro-Garcia C. et al. Prognostic factors in emphysematous pyelonephritis. Actas Urol Esp. 2013; 37: 228-232 Crossref PubMed Scopus (12) Google Scholar Moreover, in our opinion, initial approach and treatment guided by strict criteria such as Surviving Sepsis Campaign recommendations 4 Dellinger R.P. Levy M.M. Carlet J.M. et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med. 2008; 36: 296-327 Crossref PubMed Scopus (3942) Google Scholar is more reliable than radiologic criteria alone. The Management of Emphysematous Pyelonephritis and Importance of Minimally Invasive TreatmentUrologyVol. 84Issue 4PreviewEmphysematous pyelonephritis (EPN) is one of the most common clinical form of emphysematous infections of upper urinary tract.1 EPN is an acute, severe, necrotizing infection of the renal parenchyma and perirenal tissue, which causes gas within the renal parenchyma, collecting system, or perinephric tissue.2 It usually affects one kidney and occurs mostly in diabetic patients.1,3 The combination of the presence of gas-producing microorganisms, a high tissue glucose concentration, and impaired tissue perfusion favors the development of the emphysematous infections of the urinary tract. Full-Text PDF