Outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis
- 1 January 2006
- journal article
- Published by Taylor & Francis Ltd in Scandinavian Journal of Urology and Nephrology
- Vol. 40 (4), 332-338
- https://doi.org/10.1080/00365590600794902
Abstract
Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of the kidney characterized by gas formation. In order to compare the outcome of nephrectomy and kidney-preserving procedures for the treatment of EPN we reviewed our experiences of EPN over the past 18 years. The medical records of 17 patients with EPN treated between October 1986 and September 2004 were retrospectively reviewed. Abdominal X-ray and/or CT were used as diagnostic methods. Women outnumbered men (12 vs five), and all patients had diabetes. Obstruction of the corresponding reno-ureteral unit was found in one patient. Thirteen of the 17 patients (76%) had poorly controlled diabetes (hemoglobin A1c>7%). The diagnosis of EPN was confirmed by gas in the parenchymal or perinephric space as detected by abdominal X-ray or CT. Escherichia coli was the commonest organism present in urine cultures (52%), followed by Klebsiella pneumoniae (24%). Prompt efforts were made to control diabetes, and i.v. antibiotics were given. Nephrectomy was performed in 10 patients and nine patients survived (90% success rate). The success rate among those who received medical therapy only was 50% (2/4 patients). Percutaneous drainage was performed in three patients, two of whom survived (67% success rate). The overall mortality rate was 17.6% (3/17 patients). Immediate nephrectomy with glycemic control measures and antibiotic administration is crucial for the successful treatment of EPN. However, in inoperable cases, percutaneous drainage can be an effective treatment option.Keywords
This publication has 17 references indexed in Scilit:
- Percutaneous drainage and/or nephrectomy in the treatment of emphysematous pyelonephritis.Urologia Internationalis, 2003
- Acute bilateral emphysematous pyelonephritis successfully managed by medical therapy alone: A case report and review of the literatureBMC Nephrology, 2002
- Bilateral emphysematous pyelonephritisThe American Journal of Emergency Medicine, 1998
- Emphysematous pyelonephritis: A 15-year experience with 20 casesUrology, 1997
- Percutaneous Drainage in the Treatment of Emphysematous Pyelonephritis: 10-Year ExperienceJournal of Urology, 1997
- Gas-Forming Infection of the Urinary Tract: An Investigation of Fermentation As a MechanismJournal of Urology, 1990
- Emphysematous Pyelonephritis: A 5-Year Experience with 13 PatientsJournal of Urology, 1985
- Bilateral emphysematous pyelonephritisUrology, 1985
- Emphysematous PyelonephritisJournal of Urology, 1962
- PNEUMATURIA.Journal of the American Medical Association, 1898