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Krishnamoorthy S, Thiruvengadam G, Sekar H, Palaniyandi V, Ramadurai S, Narayanasamy S. Modified National Early Warning Score 2, a reliable early warning system for predicting treatment outcomes in patients with emphysematous pyelonephritis. World J Nephrol 2025; 14:103035. [DOI: 10.5527/wjn.v14.i2.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 02/21/2025] [Accepted: 03/04/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection, predominantly affecting diabetic and immunocompromised patients. It carries high morbidity and mortality, requiring early diagnosis and timely intervention. Various prognostic scoring systems help in triaging critically ill patients. The National Early Warning Score 2 (NEWS 2) scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters, but its standard form lacks specificity for risk stratification in EPN, necessitating modifications to improve treatment decision-making and prognostic accuracy in this critical condition.
AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.
METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years. A weighted average risk-stratification index was calculated for each of the three groups, mortality risk was calculated for each of the NEWS 2 scores, and the need for intervention for each of the three groups was calculated. The NEWS 2 score was subsequently modified with 0-6, 7-14 and 15-20 scores included in groups 1, 2 and 3, respectively.
RESULTS A total of 171 patients with EPN were included in the study, with a predominant association with diabetes (90.6%) and a female-to-male ratio of 1.5:1. The combined prognostic scoring of the three groups was 10.7, 13.0, and 21.9, respectively (P < 0.01). All patients managed conservatively belonged to group 1 (P < 0.01). Eight patients underwent early nephrectomy, with six from group 3 (P < 0.01). Overall mortality was 8 (4.7%), with seven from group 3 (87.5%). The cutoff NEWS 2 score for mortality was identified to be 15, with a sensitivity of 87.5%, specificity of 96.9%, and an overall accuracy rate of 96.5%. The area under the curve to predict mortality based on the NEWS 2 score was 0.98, with a confidence interval of (0.97, 1.0) and P < 0.001.
CONCLUSION Modified NEWS 2 (mNEWS 2) score dramatically aids in the appropriate assessment of treatment-related outcomes. MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.
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Affiliation(s)
- Sriram Krishnamoorthy
- Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Gayathri Thiruvengadam
- Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Hariharasudhan Sekar
- Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Velmurugan Palaniyandi
- Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Srinivasan Ramadurai
- Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
| | - Senthil Narayanasamy
- Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
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Ananthapadmanabhan S, Williams Z, Shanmugasundaram R, Wang H, Mehan N. Severe emphysematous pyelonephritis managed with staged percutaneous drainage - A Changing paradigm. Urol Case Rep 2025; 60:103033. [PMID: 40236907 PMCID: PMC11999346 DOI: 10.1016/j.eucr.2025.103033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 03/29/2025] [Accepted: 03/30/2025] [Indexed: 04/17/2025] Open
Abstract
Emphysematous pyelonephritis (EPN) is a potentially life-threatening infection of the renal parenchyma and perinephric tissues by gas-forming organisms. Historically, open surgical drainage or nephrectomy was the standard of care, however, in recent years percutaneous drainage as a minimally invasive approach has become popular. However, whether percutaneous drainage can be successful in more severe cases of EPN is less clear. We report a case of severe Class IIIb EPN managed successfully with multiple staged percutaneous drainage procedures guided by interval re-assessment of clinical, biochemical, and radiological progress in a 52-year-old male with poorly controlled Type 2 Diabetes.
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Affiliation(s)
| | - Zoe Williams
- Nepean Hospital Urology Group, Nepean Hospital, Kingswood, New South Wales, 2747, Australia
| | | | - Henry Wang
- Nepean Hospital Urology Group, Nepean Hospital, Kingswood, New South Wales, 2747, Australia
| | - Nicholas Mehan
- Nepean Hospital Urology Group, Nepean Hospital, Kingswood, New South Wales, 2747, Australia
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Yamamoto U, Yagame M, Uchida D, Hara M, Takeuchi H, Kawarazaki H. Morphological transition after medical treatment of emphysematous pyelonephritis over time-case report. BMC Nephrol 2025; 26:207. [PMID: 40275231 PMCID: PMC12023580 DOI: 10.1186/s12882-025-04135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/18/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. The treatment strategy, especially for surgical intervention, in EPN has been based on the Huang and Wan classifications. Huang's classification is based on the extent of gas and abscess spillover, while Wan's classification is based on the morphology of gas and fluid retention. Wan's classification type I EPN is considered more severe compared to type II EPN and pathophisyological mechanisms are speculated as the cause of the different presentation but the actual cause is unknown. In the present case, conservative treatment of EPN in the early stages of the disease allowed us to show that Wan's classification may represent a time series of morphologic changes throughout EPN. CASE PRESENTATION A 72-year-old woman treated for diabetes was admitted because of suspected treatment-resistant pyelonephritis. Her CT scan at presentation was suggestive of EPN and antibiotics was started. After additional medical treatment, a follow-up of CT image showed that the initial appearance of bubbly gas formation changed into a fluid-forming abscess. This transition shows that type I is an early phase image of EPN and type II image is seen following the early phase. Thereafter no change was seen in CT image and residing inflammation led to planned nephrectomy on day 35. Antibiotics were discontinued and no recurrence was confirmed. CONCLUSIONS Wan's type I and II EPN has been often reported as different pathophysiological entities. Our case shows that these two subtypes may represent stages in the progression of EPN. Medical treatment for type I may permit safe nephrectomy for type II EPN.
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Affiliation(s)
- Ukyo Yamamoto
- Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, Japan.
| | - Motoka Yagame
- Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, Japan
| | - Daisuke Uchida
- Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, Japan
| | - Masumi Hara
- Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, Japan
| | - Hideyuki Takeuchi
- Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, Japan
| | - Hiroo Kawarazaki
- Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, Japan.
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Mehta J, Devana SK, Sharma AP. Pan Abdominal Wall Emphysema in Emphysematous Pyelonephritis: Wait or Operate? Urology 2025:S0090-4295(25)00338-3. [PMID: 40216364 DOI: 10.1016/j.urology.2025.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 03/22/2025] [Accepted: 04/03/2025] [Indexed: 04/27/2025]
Affiliation(s)
- Jay Mehta
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Sudheer K Devana
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Aditya Prakash Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
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Agrawal H, Agarwal N, Gupta N. Emphysematous Pyelonephritis on X-ray Abdomen. Indian J Surg 2025; 87:405-406. [DOI: 10.1007/s12262-024-04156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 09/04/2024] [Indexed: 05/19/2025] Open
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Kumar J, Krishna N, Goyal A, Sindhu U. A Retrospective Analysis of the Clinical and Radiological Profile of Patients Admitted With Emphysematous Pyelonephritis. Cureus 2025; 17:e80893. [PMID: 40255825 PMCID: PMC12009128 DOI: 10.7759/cureus.80893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2025] [Indexed: 04/22/2025] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a potentially fatal infection of the kidney, predominantly affecting diabetic patients. Despite advances in management, predictors of mortality remain incompletely understood. Analysing the factors associated with a high risk of death can help in identifying high-risk EPN patients and initiating early, aggressive therapy. This study was conducted with the aim of understanding and describing the clinical, biochemical, and microbiological profile of patients diagnosed with EPN and analysing the factors influencing mortality. METHODS A retrospective observational study was conducted at Kasturba Hospital, Manipal (2017-2022). Data from 117 EPN patients were collected and analysed for demographic, clinical, laboratory, microbiological, and radiological characteristics. Primary endpoints used were successful treatment and all-cause mortality to assess markers of mortality. Risk factors for mortality were assessed using independent samples t-tests. Statistical significance was set at p<0.05. RESULTS A total of 117 patients were included in our study. The mean age was 55.5 years, with a female predominance (56.4%). The most common symptom reported was flank pain (77.8%). Diabetes mellitus (DM) was the most common risk factor identified in 96.6% of patients, and Escherichia coli (E. coli) was the most common isolated organism (54.7%). Most patients had Class 1 (33.3%) and Class 2 (28.2%) disease. The average duration of inpatient treatment was reported to be 17.25 days in our patients. Treatment included antibiotics (94%) and drainage procedures, including DJ stenting (55%). Of the 117 patients, mortality occurred in seven patients (6%). Elevated serum creatinine at admission was significantly associated with mortality (p=0.004), while other laboratory markers (hemoglobin A1c (HbA1c), total leukocyte count (TLC), platelet count, sodium) did not show a significant correlation. CONCLUSION Serum creatinine at admission emerged as a key predictor of mortality in EPN, emphasizing the need for early renal function assessment and close monitoring in high-risk patients. The low mortality rate observed in our cohort suggests that early intervention combining empirical antibiotic therapy guided by resistance patterns and minimally invasive drainage techniques may improve survival. Future prospective studies are needed to validate these findings and refine EPN management strategies.
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Affiliation(s)
- Joy Kumar
- Internal Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, IND
| | - Nanda Krishna
- Internal Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, IND
| | - Abhishek Goyal
- Internal Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, IND
| | - Udeept Sindhu
- Internal Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, IND
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Luo H, Starra E, Chan HF, Stephenson RR. Preoperative renal arterial embolization in high-risk nephrectomy: A case report of a 48-year-old patient with severe emphysematous pyelonephritis. Radiol Case Rep 2024; 19:4912-4916. [PMID: 39228943 PMCID: PMC11367261 DOI: 10.1016/j.radcr.2024.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 07/17/2024] [Indexed: 09/05/2024] Open
Abstract
A 48-year-old female with a background history of alcoholic liver cirrhosis and noninsulin-dependent diabetes presented to our institution with emphysematous pyelonephritis of the right kidney diagnosed on CT. Both urine and blood culture grew multidrug-resistant Escherichia coli. The patient developed severe thrombocytopenia, hyponatremia, confusion as well as septic shock. Preoperative right renal arterial embolization was performed, followed by immediate primary nephrectomy. This article reports the first documented case of preoperative angioembolization to prevent severe intraoperative hemorrhage and vascular complications in severe emphysematous pyelonephritis.
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Affiliation(s)
- Haili Luo
- Department of Medical Imaging, The Canberra Hospital, Yamba Drive, Garran, ACT, Australia, 2606
| | - Eric Starra
- Department of Urology, The Canberra Hospital, Yamba Drive, Garran, ACT, Australia, 2606
| | - Hin F. Chan
- Department of Urology, The Canberra Hospital, Yamba Drive, Garran, ACT, Australia, 2606
| | - Rowan R. Stephenson
- Department of Medical Imaging, The Canberra Hospital, Yamba Drive, Garran, ACT, Australia, 2606
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Sun M, Wei X, Xiang X, Zhang T, Zhang Y, Miao J, Wei J, Cao W, Yao Q, Zhu L, Zhou Y, Zhang L. Emphysematous pyelonephritis caused by Raoultella ornithinolytica: a case report. BMC Nephrol 2024; 25:382. [PMID: 39465368 PMCID: PMC11514820 DOI: 10.1186/s12882-024-03791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 10/04/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND Emphysematous pyelonephritis is a rare and severe urinary tract infection that is potentially life-threatening and easily progresses to septic shock. In this report, we present a unique case of emphysematous pyelonephritis caused by Raoultella ornithinolytica. CASE PRESENTATION An 86-year-old man presented with severe back pain of 3 days' duration. He had a history of hypertension and diabetes for more than 20 years, and his infection indicators and serum creatinine were elevated. Abdominal computed tomography revealed an abnormal gas shadow around his right kidney and the anterior edge of his right psoas muscle. Consequently, he was initially diagnosed with emphysematous pyelonephritis. There was no evidence of nephrolithiasis or other anatomical or structural abnormalities that could have precipitated this focal renal infection. Both blood and drainage fluid cultures revealed R. ornithinolytica. After early anti-infection treatment, percutaneous drainage and moderate control of blood glucose, the patient gradually recovered. CONCLUSIONS Emphysematous pyelonephritis caused by R. ornithinolytica is rare but has a high drug resistance rate potentially and may cause severe infections. Early diagnosis, prompt use of antibiotics that are sensitive to the organism, and decompression drainage could be the key to treatment.
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Affiliation(s)
- Meng Sun
- Department of Nephrology, Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, 6 Zhenhua East Road, Lianyungang, 222002, China
| | - Xiaobao Wei
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, 222002, China
| | - Xinyu Xiang
- Department of Nephrology, Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, 6 Zhenhua East Road, Lianyungang, 222002, China
| | - Ting Zhang
- Department of Nephrology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The First People's Hospital of Lianyungang, Lianyungang, 222002, China
| | - Yiwen Zhang
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, 222002, China
| | - Jiayi Miao
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, 222002, China
| | - Juanyu Wei
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, 222002, China
| | - Wei Cao
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, 222002, China
| | - Qing Yao
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, 222002, China
| | - Lin Zhu
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, 222002, China
| | - Ying Zhou
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, 222002, China
| | - Liyuan Zhang
- Department of Nephrology, Lianyungang Clinical College of Nanjing Medical University, The First People's Hospital of Lianyungang, 6 Zhenhua East Road, Lianyungang, 222002, China.
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Gupta S, Hegde AV, Kaul NK, Parab S, Jain TP, Andankar M, Pathak HR. A case series of emphysematous pyelonephritis in COVID-positive patients. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2024; 12:194-199. [PMID: 39308593 PMCID: PMC11411177 DOI: 10.62347/shwr9606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/16/2024] [Indexed: 09/25/2024]
Abstract
Emphysematous pyelonephritis (EPN) is a rare infectious disease affecting the renal and perirenal tissues, wherein gas formation occurs in the renal parenchyma, perinephric tissues, or collecting systems. It can be life threatening with mortality rates upto 60%. Here, we report a case series of EPN during the COVID pandemic with COVID test-positive patients who were diagnosed based on clinical signs, symptoms, and CT scans. One patient was conservatively managed, one underwent nephrectomy, and the others were treated with percutaneous drainage and pigtailing. Despite being critically ill, all the patients recovered uneventfully. Owning to the rarity of the lesion and variations in the clinical spectrum, the diagnosis of EPN is challenging. EPN requires early diagnosis and prompt management. The interventional technique depends on the clinical status of the patient and the severity of the lesion. Although the threshold of intervention is low in normal clinical practice, in covid patients, we tried to manage patients conservatively and intervened only when unavoidable.
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Affiliation(s)
- Sajal Gupta
- Department of Urology and Renal Transplantation, Father Muller Medical CollegeMangalore, Karnataka-575002, India
| | - Abheesh Varma Hegde
- Department of Urology and Renal Transplantation, Father Muller Medical CollegeMangalore, Karnataka-575002, India
| | | | - Sandesh Parab
- Department of Urology and Renal Transplantation, B.Y.L. Nair Ch. Hospital and Topiwala National Medical CollegeDr. A Nair Road, Mumbai-400008, India
| | - Tarunkumar Prakash Jain
- Department of Urology and Renal Transplantation, B.Y.L. Nair Ch. Hospital and Topiwala National Medical CollegeDr. A Nair Road, Mumbai-400008, India
| | - Mukund Andankar
- Department of Urology and Renal Transplantation, B.Y.L. Nair Ch. Hospital and Topiwala National Medical CollegeDr. A Nair Road, Mumbai-400008, India
| | - Hemant Ranganath Pathak
- Department of Urology and Renal Transplantation, B.Y.L. Nair Ch. Hospital and Topiwala National Medical CollegeDr. A Nair Road, Mumbai-400008, India
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Singh K, Greene J. Emphysematous Pyelonephritis in Cancer Patients: A Case Report With a Literature Review. Cureus 2024; 16:e65000. [PMID: 39161488 PMCID: PMC11333016 DOI: 10.7759/cureus.65000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2024] [Indexed: 08/21/2024] Open
Abstract
Emphysematous pyelonephritis (EPN) is a severe necrotising infection of the renal parenchyma which is rarely reported in cancer patients. We present a case of a 92-year-old man with urothelial carcinoma of the bladder who developed EPN after resection of the tumour. Septic shock developed and blood cultures grew extended-spectrum beta-lactamase (ESBL) Escherichia coli. Because of renal function decline with hematuria a non-contrast CT scan of the abdomen showed gas in the kidney and surrounding area consistent with EPN. After receiving appropriate antibiotics according to susceptibility testing, EPN was resolved based on a follow-up CT scan of the abdomen without requiring further surgical intervention. We review the literature and discuss the management of EPN in cancer patients.
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Affiliation(s)
- Karandeep Singh
- Internal Medicine, Government Medical College, Amritsar, Amritsar, IND
| | - John Greene
- Infectious Disease, Moffitt Cancer Center and Research Institute, Tampa, USA
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Zhang M, Luo H, Tan S, Fei T, Tang Z, Li Q, Lin H. Report on the diagnosis and treatment of 3 cases of emphysematous pyelonephritis with two different outcomes. Front Med (Lausanne) 2024; 11:1410014. [PMID: 38994336 PMCID: PMC11236536 DOI: 10.3389/fmed.2024.1410014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/18/2024] [Indexed: 07/13/2024] Open
Abstract
Background Emphysematous pyelonephritis (EPN) is a rare acute severe necrotising infection of the kidneys in clinical practice. It is characterized by the presence of gas in the renal parenchyma, collecting system, or perirenal tissue. The prognosis is poor, with a high nephrectomy rate and a mortality rate of up to 20-40%. Methods Retrospective analysis of 3 cases of emphysematous pyelonephritis with two different outcomes. Results Three patients who we described were all female with diabetes mellitus, and their blood sugar was poorly controlled. One patient with the advanced age and poor general health died due to the patient's family choosing to terminate therapy. Two patients underwent surgical procedures achieved an excellent clinical recovery. Both of them underwent percutaneous nephrostomy and perinephric abscess puncture drainage before nephrectomy. Escherichia coli were the microorganisms implicated. Conclusion EPN is a rare and severe urinary system infection. Computed tomography (CT) and microbiological culture confirmed the diagnosis. Control of diabetes, sensitive antibiotic therapy, fluid resuscitation and prompt surgical intervention are crucial.
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Affiliation(s)
- Minna Zhang
- Department of Nephrology, Tongren Municipal People’s Hospital, Tongren, China
| | - Hongxing Luo
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Su Tan
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Tao Fei
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Zhimin Tang
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Qiang Li
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Haixing Lin
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
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Bedoui MA, Saadi A, Zaghbib S, Mokadem S, Boussaffa H, Hermi A, Ayed H, Bouzouita A, Chakroun M, Ben Slama R. Risk factors for sepsis and mortality in patients with emphysematous pyelonephritis : a series of 68 cases (case series). Ann Med Surg (Lond) 2024; 86:240-244. [PMID: 38222707 PMCID: PMC10783401 DOI: 10.1097/ms9.0000000000001475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/26/2023] [Indexed: 01/16/2024] Open
Abstract
Background Emphysematous pyelonephritis (EPN) is a rare and severe necrotizing infection of the kidney with a high rate of complications and mortality. Our aim was to investigate risk factors of urosepsis and mortality in case of EPN. Materials and methods Between January 2010 and December 2022 the charts of patients diagnosed with EPN were retrospectively reviewed. Patients medical records were collected and data including demographics, BMI, EPN type, the organism causing the infection and biochemical variables were registered. The authors performed an univariate and multivariate logistic regression analysis for sepsis, septic shock, and mortality. Statistical significance was defined as a P-value of <0.05. Results Our study included 68 patients (63% females, mean age 58.6 years old). Forty-eight patients (70.6%) had diabetes. Half of the patients (50%) presented with sepsis and 11 patients (16.2%) developed a septic shock. The following factors were associated with sepsis by univariate analysis: diabetes (P=0.01), higher blood sugar on admission (P=0.01), higher leukocytic count (P<0.001), higher lymphocytic count (P<0.001), and lower platelet to leukocytes ratio (P<0.001). Multivariate regression analysis revealed that the main risk factors of urosepsis were the leukocytic (OR: 85.7; 95% CI: 9.177-800.486; P<0.001) and lymphocytic count (OR: 6.65; 95% CI: 1.228-36.050; P=0.028). Neither of the variables was significantly associated with a higher risk of mortality. Conclusion Leukocytic and lymphocytic count on admission are independent simple predictors for sepsis in patients with EPN.
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Affiliation(s)
- Mohamed A. Bedoui
- Department of Urology, Faculty of Medicine of Tunis, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
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Zanon JR, Durante H, Nóbrega LDM, Accorsi G, Pedrão PG, dos Reis R. Emphysematous pyelonephritis after urinary diversion by percutaneous nephrostomy in patient with advanced cervical cancer: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231182532. [PMID: 37389405 PMCID: PMC10302517 DOI: 10.1177/2050313x231182532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Emphysematous pyelonephritis is a severe kidney infection that is common in women and patients with diabetes mellitus, but rare in cancer patients. A 64-year-old patient with advanced uterine cervical cancer developed emphysematous pyelonephritis after urine diversion by percutaneous nephrostomy of the left kidney, which is a possible approach to this infection. Antibiotic therapy was started to achieve clinical improvement and preserve renal function, and radical nephrectomy was not an option due to the functional exclusion of the contralateral kidney. The patient progressed with worsening renal function; thus, she started outpatient hemodialysis, with improvement of the uremic encephalopathy. She died 7.7 months after admission, 1 month after treatment for emphysematous pyelonephritis. Treatment should be adjusted to the patients' needs, including maintenance of hemodialysis to improve symptoms. Further investigation is needed to identify possible causes and prevent emphysematous pyelonephritis in cancer patients.
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Affiliation(s)
- Jeferson Rodrigo Zanon
- Department of Nephrology and Palliative Care, Jales Cancer Hospital (a Barretos Cancer Hospital unit—Pio XII Foundation), Jales, Brazil
| | - Henrique Durante
- Department of Interventional Radiology, Barretos Cancer Hospital—Pio XII Foundation, Barretos, Brazil
| | | | - Guilherme Accorsi
- Department of Gynecologic Oncology, Catanduva Medical School, Catanduva, Brazil
- Department of Mastology and Gynecological Oncology, São José de Rio Preto Medical School, São José do Rio Preto, Brazil
| | - Priscila Grecca Pedrão
- Molecular Oncology Research Center, Barretos Cancer Hospital—Pio XII Foundation, Barretos, Brazil
| | - Ricardo dos Reis
- Department of Gynecoligic Oncology, Institute of Teaching and Research and Barretos Cancer Hospital—Pio XII Foundation, Barretos, Brazil
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Aggarwal D, Mandal S, Parmar K, Manoharan V, Singh S, Yadav AK, Kumar S, Sharma AP, Singh SK. Predictors of mortality and nephrectomy in emphysematous pyelonephritis: a tertiary care centre study. Ann R Coll Surg Engl 2023; 105:323-330. [PMID: 35617107 PMCID: PMC10066649 DOI: 10.1308/rcsann.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) is a deadly disease due to its associated morbidity and mortality. Attempts have been made to identify predictors of severity, mortality and need for nephrectomy in EPN with little success. METHODS We conducted an ambispective study of EPN patients between March 2014 and September 2019. Retrospective data were collected which included age, sex, comorbidities, symptoms, signs, laboratory investigations including imaging, need for dialysis, management and any complications. All patients were then followed prospectively for renal dynamic scan, stone surgery or nephrectomy. Univariate analysis was performed to identify factors affecting mortality and need for elective nephrectomy. RESULTS In total, 112 patients were included. Mean patient age was 50.01 years, 55% were female and 5% had bilateral involvement. Fever and flank pain were the most common symptoms. Diabetes was seen in 75% of cases and 30% of cases required haemodialysis at initial presentation. About 60% of patients improved with pigtail drainage. Need for nephrectomy was greater in Huang-Tseng stage 3a (14.8%). Huang-Tseng stages 3b and 4 had higher mortality rates (25%) than the other stages (2.2%). Twelve of 99 patients had non functional kidney on follow-up and underwent elective nephrectomy. Low platelet counts, high body mass index, septic shock, dialysis and higher Huang-Tseng stage were found to be predictive of mortality and renal parenchymal thickness on computed tomography scan was predictive of follow-up nephrectomy. CONCLUSIONS Thrombocytopaenia, high body mass index, septic shock, haemodialysis and higher Huang-Tseng stage are predictors of mortality and renal parenchymal thickness <5mm is a predictor of poor salvage of affected kidney on follow-up.
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Affiliation(s)
- D Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Mandal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Parmar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Manoharan
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - AK Yadav
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - AP Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - SK Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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15
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Kamei J, Sugihara T, Yasunaga H, Matsui H, Sasabuchi Y, Fujimura T, Homma Y, Kume H. Impact of early ureteral drainage on mortality in obstructive pyelonephritis with urolithiasis: an analysis of the Japanese National Database. World J Urol 2023; 41:1365-1371. [PMID: 36947175 DOI: 10.1007/s00345-023-04375-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The impact of early drainage on mortality in patients with obstructive pyelonephritis with urolithiasis was evaluated. METHODS We identified 34,924 patients in the Japanese Diagnosis Procedure Combination database with obstructive pyelonephritis with urolithiasis receiving ureteral drainage. The effects of early drainage (1-2 days) compared to those of delayed drainage (on 3-4 and ≥ 5 hospital days) on mortality were evaluated among 31,696 patients hospitalized for ≥ 5 days. Multivariate analysis was performed to identify independent factors for mortality. RESULTS The mortality rates for overall cases and those hospitalized for ≥ 5 days were 2.0% and 1.6%, respectively. Those receiving drainage on 1-2, 3-4, and ≥ 5 days had mortality rates of 1.5%, 2.0%, and 2.5%, respectively (p < 0.001). Multivariate analysis revealed that delayed drainage was an independent factor for higher mortality (odds ratio [OR] on days 3-4 and ≥ 5; 1.44, p = 0.018; and 1.69, p < 0.001). Increasing age (OR for 60 s, 70 s, and ≥ 80 years; 2.02, 3.85, and 7.77), Charlson comorbidity index score (OR, 1.41 by 1-point increase), disseminated intravascular coagulation (OR, 2.40), ambulance use (OR, 1.22), impaired consciousness at admission (disoriented, arousable with stimulation, and unarousable; OR 1.58, 2.84, and 5.50), and nephrostomy (OR, 1.65) were associated with higher mortality. In contrast, female sex (OR, 0.76) and high hospital volume (OR on 9-16, and ≥ 17 cases/year; 0.80, and 0.75) were associated with lower mortality. CONCLUSION Ureteral drainage within 2 hospital days was an independent factor for low mortality in obstructive pyelonephritis with urolithiasis. Delayed drainage could increase mortality in a time-dependent manner.
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Grants
- 20H03907 the Ministry of Education, Culture, Sports, Science, and Technology, Japan
- 21AA2007 the Ministry of Health, Labor, and Welfare, Japan
- 22AA2003 the Ministry of Health, Labor, and Welfare, Japan
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yukio Homma
- Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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16
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Wamsley CE, Morton A, Roth CG, Izes JK, Li L. Emphysematous pyelonephritis necessitating bilateral radical nephrectomy: A case report and literature review. Urol Case Rep 2023; 47:102376. [PMID: 36960082 PMCID: PMC10029357 DOI: 10.1016/j.eucr.2023.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Emphysematous pyelonephritis (EPN) is a severe, acute necrotizing infection of the kidney with gas accumulation in the renal parenchyma, collecting ducts, and/or perirenal tissue. We report a case of EPN in a 66 year-old male with uncontrolled diabetes mellitus (DM), urinary tract infection and septic shock necessitating emergent bilateral radical nephrectomy. Morphologically, the kidney parenchyma revealed severe acute bacterial pyelonephritis with extensive abscesses, gas cysts, necrosis and foci of infarctions. The uninvolved background cortex parenchyma exhibited diabetic nephropathy (DN), Class IIB. Post-operatively, the patient remained dialysis-dependent with multiple re-admissions for recurrent multi-drug resistant E. coli pyocystitis, anemia and urinary retention.
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Affiliation(s)
- Christine E. Wamsley
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Arianna Morton
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Christopher G. Roth
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Joseph K. Izes
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Li Li
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States
- Corresponding author. Thomas Jefferson University Hospital, 132 South 10th Street, Main Building, Room 285R, Philadelphia, PA, 19107, United States.
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17
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Muacevic A, Adler JR, AlAbandi A, AlDahoos M, Alfulij A. Conservative Management of a COVID-19-positive Patient With Emphysematous Pyelonephritis: A Case Report. Cureus 2023; 15:e33315. [PMID: 36741641 PMCID: PMC9894572 DOI: 10.7759/cureus.33315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
Herein, we present a case of emphysematous pyelonephritis with septic shock that was treated conservatively. A 44-year-old woman with diabetes mellitus presented to the emergency department with acute abdominal discomfort. Clinical examination revealed that the patient was conscious but vitally unstable. Therefore, the patient required inotropic support. A computed tomography scan revealed gas in the left kidney, suggestive of emphysematous pyelonephritis. Subsequently, the patient was treated conservatively and stabilized with broad-spectrum antibiotics, strict blood glucose management, and drainage.
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18
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Abu Jawdeh BG, Nguyen MC, Ryan MS, Vikram HR. Case report: Emphysematous pyelonephritis associated with kidney allograft abscess formation. Front Med (Lausanne) 2022; 9:1066512. [PMID: 36619614 PMCID: PMC9812942 DOI: 10.3389/fmed.2022.1066512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is a severe, acute necrotizing infection that is defined by the presence of gas in the kidney parenchyma. Multiple case reports have described the radiological findings and clinical course of EPN. Herein, we report on EPN including the histopathological findings in a kidney transplant recipient. Our patient presented with EPN complicated by multiorgan failure and was successfully managed with transplant nephrectomy.
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Affiliation(s)
- Bassam G. Abu Jawdeh
- Division of Nephrology, Mayo Clinic Arizona, Phoenix, AZ, United States,*Correspondence: Bassam G. Abu Jawdeh,
| | - Michelle C. Nguyen
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Margaret S. Ryan
- Department of Pathology, Mayo Clinic Arizona, Phoenix, AZ, United States
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Badawy MA, Abdelbaset M, Zahran M, Ghobrial FK, El-Ghar MA, Elsorougy A, Abdelhamid A. Diagnostic performance of pre-management computed tomography findings as a predictor of conservative treatment success in patients with emphysematous pyelonephritis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022; 53:254. [DOI: 10.1186/s43055-022-00941-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/05/2022] [Indexed: 07/28/2024] Open
Abstract
Abstract
Background
Emphysematous pyelonephritis (EPN) is one of the most serious urologic emergency which should be diagnosed and treated adequately to prevent impending septic shock and death. Computed tomography (CT) is the gold standard radiologic modality for diagnosis, grading and predicting the outcome. We aimed in this study to define the initial CT radiological findings correlated with EPN conservative management success.
Results
This study involved 54 patients (42 women and 12 males) with a mean age of 48 ± 10 years. EPN grades I, II, III, and IV were noticed in 12, 17, 20, and 5 patients, respectively. Ten patients (18.5%) received successful conservative management. On the other hand, renal drainage was needed in 42 patients (77.8%). Delayed nephrectomy was required in two cases (3.7%). In univariate and multivariate analyses, the absence of hydronephrosis and decreased air locules volume were predictors of conservative treatment success (P = 0.003 and 0.01, respectively).
Conclusions
Conservative therapy should be selected in certain patients of emphysematous pyelonephritis. Decreased air locules volume and the absence of hydronephrosis in pre-admission computed tomography were predictors for conservative therapy success.
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20
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Chen CC, Hsieh MS, Hu SY, Huang SC, Tsai CA, Tsai YC. Performance of Scoring Systems in Predicting Clinical Outcomes of Patients with Emphysematous Pyelonephritis: A 14-Year Hospital-Based Study. J Clin Med 2022; 11:jcm11247299. [PMID: 36555916 PMCID: PMC9788337 DOI: 10.3390/jcm11247299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Emphysematous pyelonephritis (EPN) is a rare but severe necrotizing infection causing there to be gas in the pelvicalyceal system, renal parenchyma, and perirenal or pararenal space. Physicians should attend to EPN because of its life-threatening septic complications. The overall mortality rate has been reported to be as high as 20−40%. In addition, most patients had diabetes mellitus (DM) and obstructive uropathy. The most common isolated microorganism is Escherichia coli. This study aims to analyze the risk factors and performance of scoring systems in predicting the clinical outcomes of patients with EPN. Materials and Methods: We collected the data of patients with EPN in this single hospital-based retrospective study from the electronic medical records of Taichung Veterans General Hospital between January 2007 and December 2020. Radiological investigations of abdominal computed tomography (CT) confirmed the diagnosis of EPN. In addition, we analyzed demographics, clinical characteristics, and laboratory data. Finally, we used various scoring systems to predict clinical outcomes. Results: A total of fifty patients with EPN, whose diagnoses were confirmed through CT, were enrolled in the study. There were 18 males (36%) and 32 females (64%), with a mean age of 64.3 ± 11.3 years. The in-hospital mortality rate was 16%. A DM of 34 (68%) patients was the most common comorbidity. Fever was the most common symptom, found in 25 (50%) patients. The Mortality in Emergency Department Sepsis (MEDS) score was 4.64 ± 3.67 for survivors and 14.25 ± 5.34 for non-survivors (p < 0.001). The National Early Warning Score (NEWS) was 3.64 ± 2.33 for survivors and 7.13 ± 4.85 for non-survivors (p = 0.046). The Rapid Emergency Medicine Score (REMS) was 5.81 ± 1.97 for survivors and 9.13 ± 3.87 for non-survivors (p = 0.024). Regarding performance of mortality risk prediction, the AUC of ROC was 0.932 for MEDS, 0.747 for REMS, and 0.72 for NEWS. Conclusions: MEDS, REMS, and NEWS could be prognostic tools for the prediction of the clinical outcomes of patients with EPN. MEDS showed the best sound performance. In those with higher scores in MEDS (≥12), REMS (≥10), and NEWS (≥8), we recommended aggressive management and appropriate antimicrobial therapy as soon as possible to reduce mortality. Further large-scale studies are required to gain a deep understanding of this disease and to ensure patient safety.
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Affiliation(s)
- Chun-Cheng Chen
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Correspondence: (S.-Y.H.); (S.-C.H.); Tel.: +886-4-23592525 (ext. 3670) (S.-Y.H.); +886-4-247395955 (ext. 34121) (S.-C.H.); Fax: +886-4-23594065 (S.-Y.H.); +886-4-24714800 (S.-C.H.)
| | - Shih-Che Huang
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Lung Cancer Diagnosis and Treatment Research Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence: (S.-Y.H.); (S.-C.H.); Tel.: +886-4-23592525 (ext. 3670) (S.-Y.H.); +886-4-247395955 (ext. 34121) (S.-C.H.); Fax: +886-4-23594065 (S.-Y.H.); +886-4-24714800 (S.-C.H.)
| | - Che-An Tsai
- Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yi-Chun Tsai
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
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21
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Newcomer JB, Myers CB, Chacon E, Kim JK, Raissi D. Percutaneous drainage for non-operative management of emphysematous pyelonephritis: Clinical characteristics and predictors of success. J Clin Imaging Sci 2022; 15:59. [PMID: 36601423 PMCID: PMC9805613 DOI: 10.25259/jcis_103_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is a necrotizing renal infection that can rapidly progress without urgent intervention. The purpose of this study was to evaluate the safety and efficacy of percutaneous nephrostomy (PN) in the management of EPN, as well as the relationship of outcomes with initial classification by the Huang-Tseng classification system and other prognostic factors such as thrombocytopenia. A retrospective review of medical records revealed seven patients with EPN treated with PN. Thirty-day survival rate was 86%, with the only mortality due to an arrhythmia secondary to underlying cardiomyopathy rather than a complication from EPN or PN. A single nephrostomy procedure served as definitive treatment in 3 patients (43%). Reintervention due to recurrence of EPN symptoms was required in 4 patients (57%), all of which initially presented with Class 3 disease or higher. Two of these four patients required nephrectomy, while the other two were successfully managed with a second drainage procedure without further recurrence of symptoms. PN appears to be a safe and generally effective management option for EPN, especially in patients who are considered poor surgical candidates. PN may serve as definitive treatment in hemodynamically stable patients with lower class of disease. In patients with higher class of disease, PN may be definitive treatment in patients who lack additional risk factors such as thrombocytopenia or serve as an effective bridge to nephrectomy.
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Affiliation(s)
- Jack Bailey Newcomer
- Department of Radiology, Medicine and Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, United States.,Corresponding author: Jack Bailey Newcomer, University of Kentucky College of Medicine, Lexington, United States.
| | - Charles Benjamin Myers
- Department of Radiology, Medicine and Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, United States
| | - Eduardo Chacon
- Department of Radiology, Medicine and Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, United States
| | - Joon Kyung Kim
- Department of Urology, Medicine and Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, United States
| | - Driss Raissi
- Department of Radiology, Medicine and Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, United States
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22
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Villasuso-Alcocer V, Flores-Tapia JP, Perez-Garfias F, Rochel-Perez A, Mendez-Dominguez N. Serratia fonticola and its role as a single pathogen causing emphysematous pyelonephritis in a non-diabetic patient: A case report. World J Clin Cases 2022; 10:10600-10605. [PMID: 36312511 PMCID: PMC9602252 DOI: 10.12998/wjcc.v10.i29.10600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/15/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diagnosis of emphysematous pyelonephritis has been described around the world for some decades, frequently associated with Escherichia coli and other anaerobic, gas-forming bacteria and mostly in patients living with diabetes. We present a case report of emphysematous pyelonephritis in a non-diabetic patient caused by Serratia fonticola as well as a brief literature review to draw attention to this rare pathogen as a cause of pyelonephritis. CASE SUMMARY A 38-year-old female presented with fever, severe pain in the right flank and changes in urinary habits. She was admitted, and emphysematous pyelonephritis was confirmed by an abdominal computerized tomography and urine cultures; the latter showed Serratia fonticola as a single pathogen. After 3 d of being treated with piperacillin/tazobactam and percutaneous drainage she became afebrile, and the gas presence reduced. CONCLUSION Emphysematous pyelonephritis infections in non-diabetic patients are rare but can be severe and life-threatening. This case suggests that Serratia fonticola infection can occur in patients undergoing invasive or instrumented procedures.
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Affiliation(s)
- Victor Villasuso-Alcocer
- Scholar at Direccion General de Calidad y Educacion en Salud, Secretaría de Salud, Mexico 11570, Mexico
| | - Juan P Flores-Tapia
- Urology Department, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida 97300, Yucatan, Mexico
| | - Fernando Perez-Garfias
- Urology Department, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida 97300, Yucatan, Mexico
| | - Andrea Rochel-Perez
- Urology Department, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida 97300, Yucatan, Mexico
| | - Nina Mendez-Dominguez
- Research and Learning, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida 97130, Yucatan, Mexico
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Storey B, Nalavenkata S, Whitcher S, Blatt A. Emphysematous Pyelonephritis: A Twelve-year Review in A Regional Centre. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2022.2021.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Fuentes A, Rojas PA, del Valle F, Ortega C, Bravo JC, Kompatzki Á. Contralateral necrotizing fascitis after left nephrectomy for emphysematous pyelonephritis. IJU Case Rep 2022; 5:511-514. [DOI: 10.1002/iju5.12528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/21/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Alberto Fuentes
- Servicio de Urología Complejo Asistencial Hospital Sotero de Rio Santiago Chile
| | - Pablo A Rojas
- Servicio de Urología Complejo Asistencial Hospital Sotero de Rio Santiago Chile
| | - Felipe del Valle
- Departamento de Urología, Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Carlidia Ortega
- Departamento de Cirugía, Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Juan Cristobal Bravo
- Departamento de Urología, Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Álvaro Kompatzki
- Servicio de Urología Complejo Asistencial Hospital Sotero de Rio Santiago Chile
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25
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Prevalence and Risk Factors of Mortality in Emphysematous Pyelonephritis Patients: A Meta-Analysis. World J Surg 2022; 46:2377-2388. [PMID: 35802159 DOI: 10.1007/s00268-022-06647-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Emphysematous pyelonephritis (EP) is a severe necrotizing infection of the renal parenchyma which is associated with significant case mortality. We sought to identify the incidence and predictive risk factors associated with EP mortality. METHODS Two electronic databases, PubMed and Web of Science, were searched from their inception until June 06, 2021 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. RESULTS Of the 1080 retrieved abstracts, 79 underwent full-text review and 45 studies were included in the final analysis, comprising a total cohort of 1303 patients and 177 mortalities. The pooled prevalence of mortality among the patients with EP disease was 13%. Our analysis found a significantly decreasing trend in mortality rates, an increasing trend in minimally invasive intervention and decreasing trends in emergency nephrectomy in the EP studies from 1985 to 2020. Significant risk factors that were associated with a negative impact on survival of EP patients included sepsis (OR = 15.99), shock (OR = 15.57), disturbance of consciousness (OR = 12.11), thrombocytopenia (OR 7.85), acute renal failure (OR = 5.41), Wan classification I (OR = 4.57), emergency nephrectomy (OR = 3.73), Huang-Tseng classification III-IV (OR = 2.4) and medical management alone (OR = 2.04). Female sex (OR = 0.52) and minimally invasive intervention (OR = 0.47) (percutaneous nephrostomy or ureteral stent placement) were associated with decreased mortality rates. CONCLUSIONS Our study results demonstrated several significant risk factors that could help guide treatment to reduce the mortality risk of EP patients. Clinically, early treatment with a combination of minimally invasive intervention and appropriate medical management may be protective for reducing mortality risk in EP patients.
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Rahoui M, Ouanes Y, Chaker K, Bibi M, Mourad Dali K, Sellami A, Ben Rhouma S, Nouira Y. Predictive factors for failure of conservative management in patients with emphysematous pyelonephritis. Ann Med Surg (Lond) 2022; 78:103930. [PMID: 35734716 PMCID: PMC9207130 DOI: 10.1016/j.amsu.2022.103930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 10/26/2022] Open
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27
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Fernandez Felix DA, Madrigal Loria G, Sharma S, Ali M, Arias Morales CE. Emphysematous Pyelonephritis Complicated With Hyperglycemic Hyperosmolar State and Sepsis: A Case Report and Literature Review. Cureus 2022; 14:e25498. [PMID: 35663692 PMCID: PMC9156399 DOI: 10.7759/cureus.25498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 12/01/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is an acute life-threatening necrotizing infection of the renal parenchyma and perirenal tissues. There are multiple treatment strategies for EPN depending on the initial classification; over the last three decades, the treatment approach has favored kidney sparing strategies and the use of nephrectomy only as salvage therapy. We report a case involving a patient with unilateral emphysematous pyelonephritis complicated with hyperglycemic hyperosmolar state (HHS), sepsis, and multiple risk factors associated with poor prognosis who was successfully treated with conservative management sparing nephrectomy. This case report aims to create awareness among clinicians that even in the presence of multiple risk factors for poor prognosis, conservative management should be considered before nephrectomy.
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Ma LP, Zhou N, Fu Y, Liu Y, Wang C, Zhao B. Emphysematous pyelonephritis: Six case reports and review of literature. World J Clin Cases 2022; 10:3268-3277. [PMID: 35647118 PMCID: PMC9082711 DOI: 10.12998/wjcc.v10.i10.3268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/11/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma, collecting system, or perinephric tissue and has a poor prognosis. EPN occurs primarily in people with diabetes mellitus (DM), but can occur in those without DM when the associated renoureteral unit is obstructed.
CASE SUMMARY We describe our experience with six patients who developed EPN. Five patients had DM, including one with diabetic ketoacidosis, one with multisystem involvements, including eye, lung and brain. Bilateral urolithiasis was present in one case, along with emphysematous cystitis. Unilateral kidney stones were present in one patient. One patient was an older man in poor general health. Five individuals survived and underwent surgical procedures including ureteral stent installation (Double J stent placement), percutaneous nephrostomy and perinephric abscess puncture drainage, while one died because the patient’s family chose to terminate therapy. Klebsiella pneumoniae and Escherichia coli were the microorganisms implicated.
CONCLUSION We conclude that EPN is a potentially fatal illness. A positive outcome necessitates early detection. Therapeutic measures should be implemented as soon as a diagnosis is made.
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Affiliation(s)
- Li-Ping Ma
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Ning Zhou
- Department of Urology Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Yan Fu
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Yan Liu
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Cong Wang
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Bin Zhao
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
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Sharma N, Quarrier S. Emphysematous pyelonephritis developing in the contralateral kidney following ureteroscopy: An unusual presentation. Urol Case Rep 2022; 43:102086. [PMID: 35520027 PMCID: PMC9062444 DOI: 10.1016/j.eucr.2022.102086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/03/2022] [Accepted: 04/13/2022] [Indexed: 11/15/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) developing in the contralateral kidney after ureteroscopic laser lithotripsy is an unusual clinical presentation and has never been reported in the literature. After ensuring sterile urine culture a 73-year-old female underwent left ureteroscopy, laser lithotripsy and stent placement for 15mm lower calyceal renal calculus. She was discharged same day and stent removed after 4 days. 1 week later she was admitted with sepsis and found to have EPN in the right kidney, with no evidence of stone or infection in the operated kidney. High index of clinical suspicion and prompt management resulted in successful outcome.
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Affiliation(s)
- Nitin Sharma
- University of Rochester Medical Center, 158 Sawgrass Drive, Second Floor, Rochester, NY 14620, USA
- Corresponding author.
| | - Scott Quarrier
- University of Medical Center, 158, Sawgrass Drive, Second Floor, Rochester, NY 14620, USA
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Factores predictivos de mortalidad e ingreso en la unidad de cuidados intensivos en pacientes con pielonefritis enfisematosa: experiencia de 5 años en un hospital terciario. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Arrambide-Herrera JG, Robles-Torres JI, Ocaña-Munguía MA, Romero-Mata R, Gutiérrez-González A, Gómez-Guerra LS. Predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis: 5-year experience in a tertiary care hospital. Actas Urol Esp 2022; 46:98-105. [PMID: 35120854 DOI: 10.1016/j.acuroe.2021.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Emphysematous pyelonephritis is a life-threatening infection of the kidney and surrounding tissues associated with a high mortality rate. The aim of this study was to determine predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis, and to propose a therapeutic algorithm based on current literature and our experience. METHODS A retrospective study was done including patients with emphysematous pyelonephritis in a single center in the north of Mexico from 2011 to 2016. Demographic, clinical, microbiological and biochemical parameters, therapeutic management, and outcomes were assessed. Factors associated with admission to intensive care unit and mortality were determined. Comparison was assessed using X2 test for categorical variables, and T-test for numerical variables. Univariate and multivariate logistic regression analyses were performed. Statistical significance was set at P < .05. RESULTS A total of 63 patients were included, of which 55 (87.3%) were females, with a mean age of 55.5 ± 12.2 years. The most common comorbidities were diabetes and hypertension. Escherichia coli was the most common isolated microorganism (51.7%) and extended-spectrum beta-lactamase-producing agents were reported in 31.7%. Conservative therapy was provided to 38.7%, double J stent 42.9%, open/percutaneous drainage 12.7%, and nephrectomy 25.3%. Overall mortality and intensive care admission were 20.6% and 36.5%, respectively. In the multivariate analysis, hemodynamic instability (P = .005), qSOFA ≥ 2 (P = .003), hypoalbuminemia (P = .02), and early nephrectomy (P = .002) were associated with intensive care admission. Huang scale 4 (P = .006) and early nephrectomy (P = .001) were associated to mortality. CONCLUSIONS Emphysematous pyelonephritis is a life-threatening disease and evidence of management is based in small case series due to the low incidence of this condition. Hemodynamic instability, hypoalbuminemia, qSOFA ≥ 2, Huang scale ≥3, and early nephrectomy are associated with poor prognosis.
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Affiliation(s)
- J G Arrambide-Herrera
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - J I Robles-Torres
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - M A Ocaña-Munguía
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - R Romero-Mata
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - A Gutiérrez-González
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - L S Gómez-Guerra
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico.
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Chawla A, Bhaskara SP, Taori R, de la Rosette JJ, Laguna P, Pandey A, Mummalaneni S, Hegde P, Rao S, K P. Evaluation of early scoring predictors for expedited care in patients with emphysematous pyelonephritis. Ther Adv Urol 2022; 14:17562872221078773. [PMID: 35222694 PMCID: PMC8874189 DOI: 10.1177/17562872221078773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Emphysematous pyelonephritis (EPN), an acute necrotizing infection of the kidney and surrounding tissues, is associated with considerable mortality. We evaluated how existing critical care scoring systems could predict the need for intensive care unit (ICU) management for these patients. We also analyzed if CT-imaging further enhances these predictive systems. Patients and Methods: A retrospective analysis of 90 consecutive patients diagnosed clinico-radiologically with EPN from January 2011 to September 2020. Five scoring systems were evaluated for their predictive ability for the need for ICU management and mortality risk: National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), ‘quick’ Sequential Organ Failure Assessment score (qSOFA), Systemic Inflammatory Response Syndrome score (SIRS), and Sequential Organ Failure Assessment score (SOFA). CT images were classified as per Huang & Tseng and evaluated as stand-alone or added to the different predictive models. Receiver operating characteristic (ROC) curves were plotted for each critical care score and CT-Class using logistic regression, to obtain the area under curve (AUC) value for comparison of ICU admission predictability. Patients were analyzed up till discharge. Results: Ninety patients were diagnosed with EPN. Twenty-six patients required ICU management and nine patients died. The best scoring system to predict the need of early ICU management is NEWS (AUC 0.884). CT Class had no independent predictive power, nor did it add significantly to improvement in most of the early warning scoring systems, but rather guided us to the need for radiological, endourological or surgical intervention. Conclusion: In patients with EPN, the NEWS scoring system predicts best the requirement of ICU care. It aids in triage of patients with EPN to appropriate early management and reduce mortality risk.
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Affiliation(s)
- Arun Chawla
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Sunil Pillai Bhaskara
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India
| | - Ravi Taori
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | | | - Pilar Laguna
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | - Akhilesh Pandey
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Sitaram Mummalaneni
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Padmaraj Hegde
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Shwetapriya Rao
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Prakashini K
- Department of Radiology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
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Hassanein M, Aleter O, Stephany BR, Eltemamy M, Augustine JJ. Emphysematous Pyelonephritis in a Kidney Transplant Recipient. Transpl Infect Dis 2022; 24:e13807. [PMID: 35148025 DOI: 10.1111/tid.13807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Brian R Stephany
- Department of Kidney Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Mohamed Eltemamy
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joshua J Augustine
- Department of Kidney Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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Desai R, Batura D. A systematic review and meta-analysis of risk factors and treatment choices in emphysematous pyelonephritis. Int Urol Nephrol 2022; 54:717-736. [PMID: 35103928 DOI: 10.1007/s11255-022-03131-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/25/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Emphysematous pyelonephritis (EPN) is an acute, severe necrotising infection of the kidney. There has been a shift from early nephrectomy to conservative methods. We conducted a meta-analysis to assess the impact of risk factors and treatment choices on outcomes in EPN. METHODS We conducted a database search of all studies in English, reporting more than 12 patients of EPN from 1980 to 2020. We compiled the demographics, clinical presentations, risk factors, critical diagnostic results, treatment modalities and outcomes, including mortality. RESULTS We identified 37 observational studies, 32 retrospective and 5 prospective. The studies reported on 1146 patients, of which 790(68.9%) were female, and 946 (82.5%) were diabetic. In addition, 184 (16.1%) patients had stones, and 235 (20.5%) had obstructive uropathy. Fever and flank pain were the most frequent symptoms. The most common clinical features were pyuria, fever, flank tenderness, and tachycardia. E. coli, Klebsiella pneumoniae and Proteus were the most frequent organisms isolated. X-ray KUB and ultrasound were used as initial diagnostic modalities, but CT scan was the usual diagnostic and confirmatory investigation. Confusion, shock, thrombocytopenia, sepsis, emergency nephrectomy and hyponatremia were significantly associated with mortality. In particular, confusion and hyponatremia were associated with a sevenfold increase in mortality risk. There was no evidence that diabetes, stones, obstructive uropathy, AKI or proteinuria was associated with higher mortality. Nevertheless, 143 of the total 1146 patients died (12.5%). While 26% of the patients who had upfront emergency nephrectomy died, only 9.7% and 10% of patients with medical management and medical management plus minimally invasive treatments died. However, patients that failed medical and minimally invasive treatments and needed salvage emergency nephrectomy had a mortality of upwards of 27%. CONCLUSION The risk factors for mortality in emphysematous pyelonephritis are shock, thrombocytopenia, confusion, hyponatremia and emergency nephrectomy. Conservative and minimally invasive treatment should be the initial management strategy for emphysematous pyelonephritis as they carry lesser mortality risks. The presence of risk factors may help predict the subset of patients who need aggressive treatment and minimally invasive treatment modalities or early nephrectomy.
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Affiliation(s)
- Rajeev Desai
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Deepak Batura
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
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Mallikarjun N, Kone K, R. K. Keerthi Rams MD. Mortality in emphysematous pyelonephritis: Can we reduce it further by using a protocol-based treatment? The results of a prospective study. Urol Ann 2022; 14:73-80. [PMID: 35197707 PMCID: PMC8815352 DOI: 10.4103/ua.ua_164_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/28/2021] [Indexed: 11/04/2022] Open
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Hsu CK, Wu SY, Yang SD, Chang SJ. Emphysematous pyelonephritis: classification, management, and prognosis. Tzu Chi Med J 2022; 34:297-302. [PMID: 35912050 PMCID: PMC9333110 DOI: 10.4103/tcmj.tcmj_257_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/28/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022] Open
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Al-Shaye M, Elkhazendar M, Al-Badra M, El Rai S. Bilateral Pneumonia and Emphysematous Pyelonephritis as an Inaugural Presentation of Diabetes: A Case Report and Review of Literature. Cureus 2021; 13:e20766. [PMID: 35111451 PMCID: PMC8794388 DOI: 10.7759/cureus.20766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
We present a case of a 60-year-old male who presented with fever, shortness of breath, left upper quadrant pain accompanied by rigors and chills with a two-week history of productive cough. He had left upper quadrant tenderness and bilateral chest crepitations. The patient became tachypneic, dyspneic, and rapidly progressed to septic shock. Chest x-ray findings of bilateral pulmonary infiltrates on admission were not correlating with the severity of his clinical picture, and blood glucose levels were very high despite a negative prior history of diabetes. Abdominopelvic computed tomography (CT) scans revealed left-sided emphysematous pyelonephritis, which was promptly managed by intravenous antibiotics and CT-guided percutaneous drainage, in addition to glycemic control. This was followed by clinical improvement and resolution of the sepsis. This case sheds light on a possible life-threatening manifestation of the hematogenous spread of pneumonia in uncontrolled diabetic patients, and can even be a de novo presentation of diabetes.
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Rafiq N, Nabi T, Rasool S, Sheikh RY. A Prospective study of Emphysematous Pyelonephritis in Patients with Type 2 Diabetes. Indian J Nephrol 2021; 31:536-543. [PMID: 35068760 PMCID: PMC8722543 DOI: 10.4103/ijn.ijn_411_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/08/2020] [Accepted: 04/24/2020] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Nadeema Rafiq
- Department of Physiology, Government Medical College, Baramulla, Jammu and Kashmir, India
| | - Tauseef Nabi
- Department of Endocrinology, MMIMSR, Ambala, Haryana, India
| | - Shahnawaz Rasool
- Department of Urology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Rayees Yousuf Sheikh
- Department of Medicine, subdivision Nephrology, SRMS IMS Bareilly, Uttar Pradesh, India
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Alaygut D, Özdemir-Şimşek Ö, Sarioglu FC, Arslansoyu-Çamlar S, Mutlubaş F, Kasap-Demir B. Unexpected cause and successful management of typical urinary tract ınfection symptoms: Answers. Pediatr Nephrol 2021; 36:3647-3651. [PMID: 33956219 DOI: 10.1007/s00467-021-05091-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Demet Alaygut
- Department of Pediatric Nephrology, University of Health Sciences Tepecik Education and Research Hospital, Konak, Izmir, Turkey.
| | - Özgür Özdemir-Şimşek
- Department of Pediatric Nephrology, University of Health Sciences Tepecik Education and Research Hospital, Konak, Izmir, Turkey
| | - Fatma Ceren Sarioglu
- Department of Radiology, Division of Pediatric Radiology, University of Health Sciences Tepecik Education and Research Hospital, Konak, Izmir, Turkey
| | - Seçil Arslansoyu-Çamlar
- Department of Pediatric Nephrology, University of Health Sciences Tepecik Education and Research Hospital, Konak, Izmir, Turkey
| | - Fatma Mutlubaş
- Department of Pediatric Nephrology, University of Health Sciences Tepecik Education and Research Hospital, Konak, Izmir, Turkey
| | - Belde Kasap-Demir
- Faculty of Medicine, Department of Pediatric Nephrology and Rheumatology, Katip Celebi University, İzmir, Turkey
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Emphysematous Pyelonephritis and Emphysematous Cholecystitis: A Result of Uncontrolled Type 2 Diabetes. Ochsner J 2021; 21:316-318. [PMID: 34566517 PMCID: PMC8442220 DOI: 10.31486/toj.20.0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing infection that results in the presence of gas in the renal parenchyma, collecting system, and surrounding tissues. Up to 95% of patients with EPN have underlying uncontrolled diabetes mellitus. Emphysematous cholecystitis (EC) is a necrotizing infection defined by the presence of gas in the gallbladder. Concurrent presentation of EPN and EC is limited to anecdotal cases in the literature. Case Report: We present the case of a 44-year-old female who arrived at the emergency department with signs of septic shock and diffuse abdominal pain. Diagnosis of EPN and EC was confirmed. Because the patient did not improve after aggressive medical therapy and percutaneous drainage and cholecystostomy, she was taken to surgery for emergency nephrectomy and cholecystectomy. Conclusion: In unusually extensive and severe cases of EPN, medical and minimally invasive procedures are not enough to control the infection. More aggressive management, including emergency surgery, should be implemented in selected patients who present with refractory septic shock associated with extensive disease.
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Sigdel B, Shrestha S, Maskey P. Forgotten DJ stent presenting with emphysematous pyelonephritis: A life threatening complication. Int J Surg Case Rep 2021; 87:106405. [PMID: 34534814 PMCID: PMC8449074 DOI: 10.1016/j.ijscr.2021.106405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) is an uncommon suppurative infection of renal parenchyma and perirenal tissue characterized by production of gas within renal parenchyma, collecting system or perinephric tissue. CASE PRESENTATION We report a case of young non diabetic female with past history of extracorporeal shock wave lithotripsy (ESWL) who presented with intermittent lower abdominal pain, dysuria and left lower limb swelling. Abdomen examination was notable for tenderness at left iliac fossa and fullness at left renal angle. Blood investigation showed leukocytosis and deranged creatinine levels. Urine analysis showed pyuria. Transabdominal ultrasound revealed left nephrolithiasis with moderate hydronephrosis, vesical calculus and double J (DJ) stent in situ. Patient was diagnosed as acute pyelonephritis and started on intravenous antibiotics. Despite on medical management, the condition deteriorated and progressed to septic shock. Computed tomography of kidneys, ureters and bladder (CT KUB) showed air fluid level in calyceal system with perinephric collection and confirmed diagnosis as emphysematous pyelonephritis. Patient underwent surgical drainage to control the sepsis. Few days later after control of sepsis and optimization, left nephrectomy and removal of retained DJ stent was done. CLINICAL DISCUSSION This case report highlights the need to consider emphysematous pyelonephritis as a possible diagnosis in patients harbouring DJ stents even in young non diabetics. Early aggressive medical management coupled with urological intervention is a valuable alternative to upfront emergent nephrectomy. However, surgery should not be delayed in patient with fulminant infection at presentation or who failed on conservative management. CONCLUSION Emphysematous pyelonephritis warrants high index of suspicion for timely diagnosis and can be fatal if not recognized early and promptly treated.
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Affiliation(s)
- Bidhan Sigdel
- Department of Surgery, Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal.
| | - Samir Shrestha
- Department of Surgery, Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Pukar Maskey
- Department of Surgery, Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal
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Sengupta S, Basu S. Outcome of conservative and minimally invasive management in emphysematous pyelonephritis. Urol Ann 2021; 13:277-281. [PMID: 34421265 PMCID: PMC8343272 DOI: 10.4103/ua.ua_85_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022] Open
Abstract
Context: Developing countries. Introduction: Emphysematous pyelonephritis (EPN) is a urologic emergency characterized by acute necrotizing infection with the presence of gas in the kidney, perinephric space, and/or urinary collecting system. Materials and Methods: It is a retrospective study of inpatients at the Department of Urology, RG Kar Medical College and Hospital, Kolkata, which includes twenty patients diagnosed as EPN between September of 2018 and May of 2020. Results: Patients were classified as per computed tomography (CT) severity grading proposed by Huang and Tseng. In our study, medical management with antibiotics was effective in 10% of patients. Twenty percent of patients were treated with medical management and internal ureteral stenting. Fifty percent of the patients were treated with medical management and percutaneous nephrostomy (PCN). Ten percent needed PCN drainage in addition to Double J (DJ) stenting. Ten percent needed percutaneous drainage of perinephric abscess along with PCN. Ten percent of patients were treated with open drainage in addition to DJ stenting and percutaneous drainage of perinephric collection as they failed to respond to minimally invasive intervention alone, with repeat ultrasonography showing persistent collection. There was no mortality in the group. Conclusion: EPN patients are mostly moribund with multiple comorbidities. It is vital to comprehend the management with a prompt CT imaging. Proactive hemodynamic stabilization, antimicrobial therapy, complementing it with DJ stenting and/or PCN in cases not responding to antibiotics alone, can treat most of the patients with this pathology.
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Affiliation(s)
- Soumish Sengupta
- Department of Urology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Supriyo Basu
- Department of Urology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
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Liston K, Manecksha RP, Woods CP. Hyperglycaemic crisis secondary to emphysematous pyelonephritis. BMJ Case Rep 2021; 14:e242617. [PMID: 34380678 PMCID: PMC8359521 DOI: 10.1136/bcr-2021-242617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old woman presented to the emergency department acutely unwell. Initial investigations revealed hyperglycaemia, ketosis and an acute kidney injury precipitated by urosepsis. She was found to have a new diagnosis of diabetes mellitus (type 2) with a glycated haemoglobin (HbA1c) of 156 mmol/mol. CT imaging of the abdomen and pelvis revealed unilateral emphysematous pyelonephritis (EPN), radiologically classified as stage 3 severity with gas extending beyond the renal collecting system. Escherichia coli was grown on blood and urine cultures. This was sensitive to second-generation cephalosporin cefuroxime. The patient was managed with fluid resuscitation, intravenous antibiotics and renal system decompression with urinary catheter insertion. She was commenced on an intravenous insulin infusion for hyperglycaemic crisis. This case illustrates a rare presentation of hyperglycaemic crisis precipitated by EPN in a patient without a previously known diagnosis of diabetes, successfully treated with medical management alone. Close clinical and radiological follow-up was arranged to monitor the need for future nephrectomy.
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Affiliation(s)
- Katie Liston
- Endocrinology, HSE Library East, Naas, Ireland
- Endocrinology, Naas General Hospital, Naas, Kildare, Ireland
- Tallaght University Hospital, Dublin, Dublin, Ireland
| | - Rustom P Manecksha
- Urology, Tallaght University Hospital, Dublin, Dublin, Ireland
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Conor P Woods
- Endocrinology, Naas General Hospital, Naas, Kildare, Ireland
- Tallaght University Hospital, Dublin, Dublin, Ireland
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Godzisz M, Mitura P, Widz D, Sudoł D, Kuliniec I, Bar K. Concurrent Bilateral Emphysematous Pyelonephritis and Emphysematous Cystitis: A Case Report of Glomerulonephritis Severe Complication. Res Rep Urol 2021; 13:375-379. [PMID: 34189131 PMCID: PMC8232954 DOI: 10.2147/rru.s315755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/28/2021] [Indexed: 12/04/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC) are severe, necrotizing emphysematous urinary tract infections (EUTI) characterized by the presence of gas in the lumen and wall of the urinary tract and renal parenchyma. EUTIs are quite uncommon, but combination of bilateral EPN and EC is extremely rare. We report a case of 57-year-old diabetic female diagnosed with septic shock due to concurrent bilateral EPN and EC. Patient was successfully treated with a drainage of pelvicalyceal systems and the bladder combined with a conservative approach. This unique case presents a possible association between glomerulonephritis and EUTI.
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Affiliation(s)
- Michał Godzisz
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Mitura
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
| | - Damian Widz
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
| | - Damian Sudoł
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
| | - Iga Kuliniec
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Bar
- Department of Urology and Urologic Oncology, Medical University of Lublin, Lublin, Poland
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Kamei J, Yamamoto S. Complicated urinary tract infections with diabetes mellitus. J Infect Chemother 2021; 27:1131-1136. [PMID: 34024733 DOI: 10.1016/j.jiac.2021.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
Patients with diabetes mellitus (DM) sometimes exhibited impaired immune function and aggravated infectious diseases. Urinary tract infection (UTI) is one of the major complications of DM. A systematic literature search was performed in PubMed and Cochrane Library using the following keywords: diabetes mellitus, urinary tract infection, asymptomatic bacteriuria, emphysematous pyelonephritis, emphysematous cystitis, renal papillary necrosis, and sodium-glucose co-transporter 2 (SGLT2) inhibitors. The treatment of UTI in DM patients is not different from that in non-DM patients, and asymptomatic bacteriuria should not be screened or treated. Emphysematous pyelonephritis is a life-threatening renal infection with gas in the renal parenchyma or perirenal space, and 95% of affected patients had DM. Abdominal computed tomography is useful for diagnosis and determining treatment strategies. Medical management and percutaneous drainage are standard initial treatment, and subsequent nephrectomy for non-responders is considered. Nephrectomy, as an initial treatment, should be limited to a selected group of patients with severe conditions. In contrast, antibiotics, glycemic control, and bladder drainage are adequate treatment for most cases of emphysematous cystitis. SGLT2 inhibitors significantly increased the incidence of genital tract infection, but not that of UTI, pyelonephritis, or urosepsis. Here, we present cumulative evidence about etiology and management for complicated UTI with DM, but there was little information about racial differences and further evidence focusing on Asian population will be needed.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan.
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
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Robles-Torres JI, Ocaña-Munguía MA, Arrambide-Herrera JG, Martínez-Fernández AM, Romero-Mata R, Gómez-Guerra LS. What is the prognosis of emphysematous pyelonephritis associated with extended-spectrum beta-lactamases producing microorganisms? Asian J Urol 2021; 9:146-151. [PMID: 35509482 PMCID: PMC9051347 DOI: 10.1016/j.ajur.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/20/2020] [Accepted: 12/18/2020] [Indexed: 12/03/2022] Open
Abstract
Objective To describe the microbiological characteristics in emphysematous pyelonephritis (EPN), demonstrate the frequency of extended-spectrum beta-lactamase (ESBL) microorganisms, and determine if these microorganisms are associated with the prognosis of patients with EPN. Methods We conducted a retrospective study in patients with a diagnosis of EPN in a tertiary care hospital of the northeast region of Mexico during the period from January 2011 to January 2016. Clinical variables were analyzed to determine association with the presence of ESBL-producing microorganisms. Statistical significance was set with p<0.05. Results A total of 63 patients were included; 55 (87.3%) of them were females, with a median age of 55 (interquartile range: 45–65) years. Conservative management was indicated in 38.1%; 42.9% were treated with ureteral stent; 12.7% with open or percutaneous drainage; 15.8% with early nephrectomy; and 9.5% with delayed nephrectomy. Reported mortality was 13 (20.6%) cases; 23 (36.5%) cases required admission to the intensive care unit. The most frequent microorganism isolated was Escherichia coli (n=34, 53.9%). ESBL microorganisms were found in 31.7% of the population. No significant association of ESBL was found with admission to the intensive care unit, or with increased mortality. Conclusions To our knowledge, this is the first study that evaluates ESBL microorganisms as a prognostic factor in EPN. Risk factors associated with a poor prognosis in patients with EPN have been described. The microbiological factors, specifically ESBL-producing bacteria, do not seem to influence in the prognosis of these patients.
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Krishnamoorthy S, Zumla A, Sekar H, Muneer A, Thiruvengadam G, Kumaresan N. Prognostic scoring system and risk stratification in patients with emphysematous pyelonephritis: an 11-year prospective study at a tertiary referral centre. BJU Int 2021; 127:418-427. [PMID: 32871043 DOI: 10.1111/bju.15225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To define pre-morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes. PATIENTS AND METHODS From January 2009 to December 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non-contrast computed tomography of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1, patients who survived without any intervention; Group 2, those who survived with surgical intervention; and Group 3, those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. RESULTS Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n = 22), Group 2 (n = 102) and Group 3 (n = 7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common comorbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (P < 0.001). CONCLUSIONS A multi-disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture-specific antibiotics with identification of prognostic indicators and risk stratification, allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.
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Affiliation(s)
- Sriram Krishnamoorthy
- Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London (UCL), London,, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Hariharasudhan Sekar
- Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Asif Muneer
- Division of Surgery and Interventional Science UCL, Department of Urology and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Gayathri Thiruvengadam
- Department of Bio-Statistics, Faculty of Allied Health Science, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Natarajan Kumaresan
- Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Humphreys WJE, Barton J, Batchelor D, Mortier JR. Extension of gas into the abdominal wall secondary to recurrent coliform emphysematous cystitis in a diabetic dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- William James Edward Humphreys
- Department of Small Animal Clinical Science: Diagnostic Imaging Institute of Veterinary Science, University of Liverpool Neston UK
| | - James Barton
- Department of Small Animal Clinical Science: Internal Medicine Institute of Veterinary Science, University of Liverpool Neston UK
| | - Daniel Batchelor
- Department of Small Animal Clinical Science: Internal Medicine Institute of Veterinary Science, University of Liverpool Neston UK
| | - Jeremy R. Mortier
- Department of Small Animal Clinical Science: Diagnostic Imaging Institute of Veterinary Science, University of Liverpool Neston UK
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Nabi T, Rafiq N, Rahman MHU, Rasool S, Wani NUD. Comparative study of emphysematous pyelonephritis and pyelonephritis in type 2 diabetes: a single-centre experience. J Diabetes Metab Disord 2020; 19:1273-1282. [PMID: 33553028 DOI: 10.1007/s40200-020-00640-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Emphysematous pyelonephritis (EPN) patients with type 2 diabetes (T2D) have severe complications and high morbidity with poor prognosis as compared to Pyelonephritis. The aim was to study clinical features, microbiological profile, complications of EPN and pyelonephritis in T2D patients. METHODS This was a hospital-based prospective study done on 200 T2D patients with upper UTI. Various clinical, biochemical parameters and urine examination and culture were monitored. Patients were followed up for 6 months with respect to number of UTIs, glycemic control and renal parameters. RESULTS Pyelonephritis was present in 180(90%) and EPN in 20(10%) of upper UTI patients. Longer duration of diabetes, presence of nephropathy, chronic kidney disease (CKD), hypertension (HTN), history of symptomatic UTI in a prior year, renal calculi and obstruction increase the risk of EPN. Patients with EPN commonly present with vomiting, flank pain altered sensorium and renal tenderness. Complications like diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), multiorgan dysfunction syndrome (MODS), acute kidney injury (AKI) and hypotension occur frequently in EPN as compared to pyelonephritis in T2D patients. Patients with EPN had poor glycemia and lower estimated glomerular filtration rate (eGFR) as compared to pyelonephritis. Bacteriuria was present in 90% and 66.7% of EPN and pyelonephritis patients respectively. E. coli was the most common isolate in both UTI groups. A significant number of EPN patients develop recurrent UTI. Patients with EPN have an improvement in glycemia on follow up, but renal parameters do not improve on follow up, while as pyelonephritis patients have an improvement in glycemia and renal parameters with intensive treatment. Recurrent UTI in upper UTI patients leads to worsening of glycemia and renal parameters. CONCLUSION Complications frequently occur in EPN patients as compared to pyelonephritis.
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Affiliation(s)
- Tauseef Nabi
- Department of Endocrinology, MMIMSR, Ambala, Haryana India
| | - Nadeema Rafiq
- Department of Physiology, Govt. Medical College, Baramulla, J&K India
| | | | - Shahnawaz Rasool
- Department of Urology, Govt. Medical College, Srinagar, J&K India
| | - Nayeem U Din Wani
- Department of Microbiology, Govt. Medical College, Srinagar, J&K India
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Krol BC, Hemal AK, Fenu EM, Blankenship HT, Pathak RA. A rare case of emphysematous pyelonephritis caused by Candida parapsilosis and Finegoldia magna complicated by medical care avoidance. CEN Case Rep 2020; 10:111-114. [PMID: 32909234 PMCID: PMC7480896 DOI: 10.1007/s13730-020-00531-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/30/2020] [Indexed: 11/02/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is a necrotizing gas producing infection of the renal parenchyma that commonly occurs in patients with diabetes. EPN requires early diagnosis and treatment due to the possible life-threatening septic complications. We report a rare case of EPN caused by an unfavorable mixed infection of Candida parapsilosis and Finegoldia magna. To our knowledge, this is the first reported case of EPN caused by Finegoldia magna. A 62-year-old male with diabetes mellitus (DM) presented with abdominal pain, shortness of breath, and nausea in which a diagnosis of septic shock was made due to EPN. Our patient first noticed abdominal pain 3 weeks prior to hospital presentation; however, he avoided getting treatment due to a fear of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This patient exhibited deterioration and expired after surgical intervention despite uneventful nephrectomy. This case suggests that medical care avoidance behaviors among patients could potentially complicate their clinical course.
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Affiliation(s)
- Bridget C Krol
- Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC, 27101, USA.
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, 140 Charlois Blvd, Winston-Salem, NC, 27103, USA
| | - Elena M Fenu
- Department of Pathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Heath T Blankenship
- Department of Pathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ram A Pathak
- Department of Urology, Wake Forest School of Medicine, 140 Charlois Blvd, Winston-Salem, NC, 27103, USA
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