Emphysematous Pyelonephritis In Patient Research Articles

979 Emphysematous Pyelonephritis in a Diabetic Patient with Horseshoe Kidney: Case Study and Literature Review

Abstract We present to you the case of a 54-year-old female with a background of horseshoe kidney presenting with a fever, right-sided flank pain, and raised inflammatory markers. This presentation was on a background of recurrent urinary tract infections which were managed conservatively with antibiotics. CT-KUB revealed pockets of gas in both kidneys and within the pelvis, with wall thickening of the left renal pelvis. She subsequently received broad spectrum antibiotics and a suprapubic catheter. Bilateral JJ stents were inserted, and ultrasound was performed in the days following to rule out hydronephrosis. Subsequently, a nephrostomy tube was inserted. The patient clinically improved over time. Horseshoe kidney is a rare anomaly, presenting multiple challenges when managing emphysematous pyelonephritis in these patients. Emphysematous pyelonephritis (EPN) is a necrotising renal infection that leads to the formation of gas in the renal parenchyma, collecting ducts, and surrounding tissue. In the past, multiple eponyms have been used to describe these conditions: ‘renal emphysema’, ‘pneumonephritis’. The pathophysiology of this benign condition is multifactorial. The gas formation that occurs can be either focal or diffuse and has the capability of tracking into perinephric and paranephric spaces. Approximately 90% of these patients have an underlying diagnosis of uncontrolled diabetes mellitus with pathogens that can produce gas, whilst 10% have urinary tract obstructions. EPN is rare, and the occurrence in a diabetic patient with horseshoe kidney has rarely been reported. The presence of a horseshoe kidney makes management more difficult. Few cases have been reported in the literature.

Radiološki nalaz pneumomedijastinuma kao retke komplikacije emfizematoznog pijelonefritisa

Introduction: Emphysematous pyelonephritis is a rare, acute, and life-threatening necrotizing renal infection caused by gas-producing facultative anaerobes, such as Escherichia coli, Klebsiella, and Proteus, most commonly in the setting of underlying diabetes mellitus. Pneumomediastinum is a rare imaging finding in this disease, and a high index of suspicion is required for diagnosing emphysematous pyelonephritis in patients presenting with pneumomediastinum, in the right clinical setting. Case presentation: We present the case of a middle-aged female patient with symptoms and laboratory findings indicating infection, renal failure, and hyperglycemia, and a personal history of diabetes mellitus. The imaging procedures revealed findings of a severe and advanced necrotizing renal infection with parenchymal destruction and intraparenchymal gas collections extending into the perirenal and pararenal spaces. We established the diagnosis of emphysematous pyelonephritis accompanied by perirenal abscess formation and pneumoretroperitoneum, with gas collections propagating into the mediastinum. In the setting of such a severe form of infection, the patient underwent immediate surgery with left nephrectomy. Despite prompt and intensive treatment, the patient unfortunately succumbed to the disease during the postoperative period. Conclusion: Pneumomediastinum is a rare complication of retroperitoneal processes, and, when present, indicates their extensiveness, often being an ominous prognostic sign. By presenting this case, we aim to highlight the severity of this form of renal infection and the unequivocal need for immediate response, as well as to emphasize the significance of imaging findings, which are somewhat unusual, but should raise suspicion of an insidious and serious retroperitoneal infection.

A Prospective study of Emphysematous Pyelonephritis in Patients with Type 2 Diabetes.

Introduction:Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma. There is a lack of studies on follow up of EPN patients. The study aimed to explore the effect of EPN in patients with type 2 diabetes (T2D) on glycemic and renal parameters on follow up, and factors suggesting the failure of medical treatment.Methods:This was a hospital-based prospective study done over a period of 3 years on newly diagnosed consecutive 20 patients of emphysematous pyelonephritis (EPN) with T2D. Study analyzed the clinical, laboratory, radiological, microbiological findings, complications, treatment modality, and outcome. All patients were followed up for 6 months with respect to the number of urinary tract infections (UTIs), glycemic control, and renal parameters.Results:Most of the patients were postmenopausal females with longer duration of diabetes and complicated by triopathy. Fever and renal angle tenderness were the most common clinical finding. The majority of our patients 12 (60%) had EPN (class 1 and 2). Severe hyperglycemia was present in 19 (95%), hyperosmolar hyperglycemic state (HHS) in 5 (25%), diabetic ketoacidosis (DKA) in 3 (15%), and acute kidney injury (AKI) in 15 (75%). Bacteriuria was present in 90% and bacteremia in 30%. E. coli was the most common organism isolated (80%). The survival rate was 90%, with failure of medical treatment in 30%. Renal obstruction and worsening azotemia predicted the failure of medical management. The significant number (11, 55%) of patients developed recurrent UTI on follow up. Factors that increased the risk of recurrent UTI in EPN were chronic kidney disease, poor glycemia, and renal obstruction. The recurrent UTI patients had significantly higher glycosylated hemoglobin A1c (HbA1c) at follow up than at baseline, but renal parameters did not differ.Conclusions:We recommend early aggressive medical treatment of EPN. Altered sensorium, renal obstruction, and deteriorating renal function may suggest the failure of medical treatment.

Emphysematous pyelonephritis: the impact of urolithiasis on disease severity

BackgroundEmphysematous pyelonephritis is a severe infection of the kidney associated with formation of gas in the renal parenchyma and/or collecting system. The purpose of this study was to evaluate outcomes of patients with emphysematous pyelonephritis in a contemporary cohort and to evaluate the impact of urolithiasis on disease severity.MethodsA search of all imaging reports at University of California San Francisco (UCSF) for the term “emphysematous pyelonephritis” was undertaken from 2003–2014. Patients were included if there was clinical evidence of infection, no recent urologic instrumentation, and computerized tomography (CT) demonstrating gas in the renal parenchyma or collecting system. Clinical and laboratory variables were obtained from medical records.ResultsA total of 14 cases were identified. The majority of patients (57%) had gas confined to the collecting system. Three patients (21%) had gas in the renal parenchyma and 3 patients (21%) had gas extending into perirenal tissues. A total of 8 patients (57%) had concomitant urolithiasis. Seven patients (50%) were managed with antibiotic therapy alone while 6 patients (43%) required percutaneous drainage. No patients required immediate nephrectomy. There were no deaths. Patients with urolithiasis had less severe emphysematous pyelonephritis than patients without urolithiasis (P<0.05).ConclusionsThe majority of patients in this study had gas contained within the collecting system and were treated successfully with antibiotics alone. Percutaneous drainage was successfully utilized in patients with more advanced disease. No patients required emergent nephrectomy. Emphysematous pyelonephritis in patients with urolithiasis was less severe than in patients without urolithiasis.

Emphysematous Pyelonephritis in Patient with Diabetes and Renal Cell Carcinoma

Emphysematous pyelonephritis (EPN) usually happens in diabetes. It is reported a correlation between the Renal Cell Carcinoma (RCC) with diabetes. This is a rare case of PEN and RCC in diabetes which occur simultaneously. We present a case of 51 year old male referred with right ?ank mass and medical history of diabetic disease. Renal ultrasound revealed a solid tumor at the upper pole of the right kidney. Plain abdominal X-ray showed a lot of gas, fecal material, and patches of alcifcation in the right upper abdomen. On abdominal computed tomography found a collection of gas located in the upper right abdomen. An irregular solid tumor detected at the upper pole of the right kidney. The tumors was obtained at surgery and emphysematous pyelonephritis was found and then nephrectomy performed. Histopathological examination revealed a Renal Cell Carcinoma besides emphysematous pyelonephritis. The patient had no postoperative serious complications during his hospital stay and his symptoms resolved completely. We report the rare case with an occurrence of EPN and RCC simultaneously in diabetes.

A case series of emphysematous pyelonephritis.

Introduction. Emphysematous pyelonephritis (EPN) is an uncommon infection characterized by gas in the renal parenchyma and surrounding tissues. It is rapidly progressive, requiring appropriate therapy to salvage the infected kidney. Case Description. The case series presents 5 patients with a clinical and radiologic diagnosis of EPN. Each patient had a unique predisposing factor for developing EPN. Early goal directed therapy with intravenous fluids and antibiotics was given. This was followed by less invasive urologic interventions in an attempt to avoid nephrectomy and thereby salvage the infected kidney. All five patients were discharged in clinically stable conditions. Discussion and Conclusion. This case series provides added practice based support to available literature for managing EPN. Early goal directed medical therapy for sepsis coupled with interventional urologic procedures is a valuable alternative to circumvent an upfront emergent nephrectomy, except in cases where a fulminant infection may be present at the time of admission or develop later on in the course of the patients illness despite conservative line of therapy. It also highlights the importance of considering a diagnosis of EPN in patients with urinary infections, who have certain common predisposing factors listed in our case series.

Emphysematous Pyelonephritis: Surgical Implications

Emphysematous pyelonephritis in patients with diabetes mellitus is increasingly recognised as a disease requiring urgent and aggressive treatment. We present 3 cases of emphysematous pyelonephritis; 1 patient required percutaneous nephrostomy followed by nephroureterectomy but the other 2 were successfully managed with antibiotics and control of diabetes. Diagnosis was confirmed by sequential imaging techniques which demonstrated an inflammatory renal mass associated with gas and fluid.