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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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Nishikawara M, Harada M, Yamazaki D, Kakegawa T, Hashimoto K, Kamijo Y. A case of emphysematous pyelonephritis in an older man with poorly controlled type 2 diabetes mellitus. CEN Case Rep 2024; 13:161-167. [PMID: 37737333 PMCID: PMC11144164 DOI: 10.1007/s13730-023-00821-7] [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: 04/17/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection characterized by gas retention and a poor prognosis. We present the case of a 75-year-old man who was diagnosed early with EPN and received multidisciplinary treatment. He had poorly controlled type 2 diabetes mellitus (DM) and chronic kidney disease (CKD), and was treated with oral hypoglycemic drugs, including a sodium-glucose co-transporter-2 inhibitor. He experienced the onset of back pain in the midsection of his back, tenderness in the costovertebral angle, and a high fever (> 39 °C), accompanied by tachycardia, hypotension, and tachypnea. The patient was diagnosed with pyelonephritis and septic shock. Immediate measures encompassing empirical antibiotic therapy, administration of noradrenaline, blood glucose regulation, and urethral catheterization were implemented. However, due to the persistent fever (> 38 °C) and lack of improvement in his condition, abdominal computed tomography (CT) was repeated on the fourth day. This revealed the presence of gas around the right kidney parenchyma, leading to a diagnosis of EPN that had evolved from acute pyelonephritis. Subsequently, percutaneous drainage of the right kidney parenchyma was performed. Subsequently, multidisciplinary treatment was continued, and his condition gradually improved. Clinicians should evaluate abdominal CT when acute pyelonephritis does not improve within a few days of antibiotic therapy. Disease progression from acute pyelonephritis to EPN should be considered in patients with DM and CKD.
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Affiliation(s)
- Mayuka Nishikawara
- Division of Nephrology, Nagano Municipal Hospital, 1333-1, Tomitake, Nagano, 381-8551, Japan
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Makoto Harada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Daiki Yamazaki
- Division of Nephrology, Nagano Municipal Hospital, 1333-1, Tomitake, Nagano, 381-8551, Japan
| | - Tetsuji Kakegawa
- Division of Nephrology, Nagano Municipal Hospital, 1333-1, Tomitake, Nagano, 381-8551, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.
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Trujillo-Santamaría H, Robles-Torres JI, Teoh JYC, Tanidir Y, Campos-Salcedo JG, Bravo-Castro EI, Wroclawski ML, Yeoh WS, Kumar S, Sanchez-Nuñez JE, Espinoza-Aznar JE, Ragoori D, Hamri SB, Aik OT, Tarot-Chocooj CP, Shrestha A, Lakmichi MA, Cosentino-Bellote M, Vázquez-Lavista LG, Kabre B, Tiong HY, Arrambide-Herrera JG, Gómez-Guerra LS, Kutukoglu U, Alves-Barbosa JAB, Jaspersen J, Acevedo C, Virgen-Gutiérrez F, Agrawal S, Duarte-Santos HO, Ann CC, Castellani D, Gahuar V. A novel mortality risk score for emphysematous pyelonephritis: A multicenter study of the Global Research in the Emphysematous Pyelonephritis group. Curr Urol 2024; 18:55-60. [PMID: 38505163 PMCID: PMC10946659 DOI: 10.1097/cu9.0000000000000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022] Open
Abstract
Background Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality. We aimed to formulate a score that classifies the risk of mortality in patients with EPN at hospital admission. Materials and methods Patients diagnosed with EPN between 2013 and 2020 were retrospectively included. Data from 15 centers (70%) were used to develop the scoring system, and data from 7 centers (30%) were used to validate it. Univariable and multivariable logistic regression analyses were performed to identify independent factors related to mortality. Receiver operating characteristic curve analysis was performed to construct the scoring system and calculate the risk of mortality. A standardized regression coefficient was used to quantify the discriminating power of each factor to convert the individual coefficients into points. The area under the curve was used to quantify the scoring system performance. An 8-point scoring system for the mortality risk was created (range, 0-7). Results In total, 570 patients were included (400 in the test group and 170 in the validation group). Independent predictors of mortality in the multivariable logistic regression were included in the scoring system: quick Sepsis-related Organ Failure Assessment score ≥2 (2 points), anemia, paranephric gas extension, leukocyte count >22,000/μL, thrombocytopenia, and hyperglycemia (1 point each). The mortality rate was <5% for scores ≤3, 83.3% for scores 6, and 100% for scores 7. The area under the curve was 0.90 (95% confidence interval, 0.84-0.95) for test and 0.91 (95% confidence interval, 0.84-0.97) for the validation group. Conclusions Our score predicts the risk of mortality in patients with EPN at presentation and may help clinicians identify patients at a higher risk of death.
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Affiliation(s)
| | - José Iván Robles-Torres
- Department of Urology, Hospital Universitario “Dr. José Eleuterio Gonzalez”, Monterrey, México
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | | | | | - Marcelo Langer Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, BP-a Beneficência Portuguesa de São Paulo, Sao Paulo, Brazil
- Faculdade de Medicina do ABC, Santo André, Brazil
| | - W. S. Yeoh
- Department of Urology, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Santosh Kumar
- Department Urology, Christian Medical College, Vellore, Tamilnad, India
| | | | | | - Deepak Ragoori
- Department Urology, Asian Institute of Nephrology and Urology, Hyderabad, India
| | - Saeed Bin Hamri
- Department Urology, King Abdulaziz National Guard Hospital, Riyadh, Saudi Arabia
| | - Ong Teng Aik
- Division of Urology, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Anil Shrestha
- National Academy of Medical Sciences, Bir Hospital and B&B Hospital, Gwarko Lalitpur, Nepal
| | - Mohamed Amine Lakmichi
- Department of Urology, University Hospital Mohammed the VI of Marrakesh, Marrakesh, Morocco
| | - Mateus Cosentino-Bellote
- Department of Urology, Federal University of Paraná, School of Medicine, Hospital das Clínicas, Curitiba, Brazil
| | | | - Boukary Kabre
- Department of Urology, Hospital Yalgado Ouedraogo Ouagadouga, Kadiogo, Burkina Faso
| | - Ho Yee Tiong
- Department of Urology, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | | | | | - Umut Kutukoglu
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Jorge Jaspersen
- Department Urology, Hospital General de México “Dr. Eduardo Liceaga”, México City, México
| | - Christian Acevedo
- Department Urology, Hospital General de México “Dr. Eduardo Liceaga”, México City, México
| | | | | | | | - Chai Chu Ann
- Division of Urology, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Daniele Castellani
- Department of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche Region, Ancona, Italy
| | - Vineet Gahuar
- Department of Minimally Invasive Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Quintana-Gamboa A, Flores-Tapia JP, Villasuso-Alcocer V, Mendez-Dominguez N. Manifestations and outcomes in patients with emphysematous pyelonephritis: Clinical series from southeast Mexico. MEDICINA CLÍNICA PRÁCTICA 2023; 6:100345. [DOI: 10.1016/j.mcpsp.2022.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
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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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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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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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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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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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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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Ochoa-Arvizo MA, Montelongo-Rodríguez FA, Robles-Torres JI, Ruíz-Galindo E, Guerra-Castañón CD, Arrambide-Gutiérrez G. Emphysematous Pyelonephritis in a Horseshoe kidney. Urology 2020; 144:15-16. [DOI: 10.1016/j.urology.2020.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
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Vernuccio F, Patti D, Cannella R, Salvaggio G, Midiri M. CT imaging of acute and chronic pyelonephritis: a practical guide for emergency radiologists. Emerg Radiol 2020; 27:561-567. [PMID: 32445022 DOI: 10.1007/s10140-020-01788-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/04/2020] [Indexed: 01/20/2023]
Abstract
Contrast-enhanced CT is not routinely indicated in uncomplicated urinary infections, but it may be necessary in patients with specific risk factors (i.e., diabetes, immunocompromised patients, history of stones, or prior renal surgery) or in patients not responding to antibiotics and in detecting complications of pyelonephritis. CT is the gold standard for imaging assessment of pyelonephritis severity. Imaging appearance of acute pyelonephritis, including focal (i.e., wedge-shaped zones of decreased attenuation or hypodense mass) and diffuse (i.e., global enlargement, poor parenchymal enhancement, lack of excretion of contrast, fat stranding) forms, needs to be differentiated from renal infarction, renal lymphoma, and interstitial nephritis. Chronic pyelonephritis-which appears as focal polar scars with underlying calyceal distortion, global atrophy, and hypertrophy of residual tissue-may mimic at imaging lobar infarcts. This pictorial essay reviews the CT imaging appearance of acute and chronic pyelonephritis, their uncommon subtypes, and their complications, with key features for early diagnosis. Their knowledge is crucial for emergency and abdominal radiologists to avoid misdiagnosis with malignancy and to guide the clinician towards the appropriate medical or surgical treatment.
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Affiliation(s)
- Federica Vernuccio
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza G. D'Alessandro, University of Palermo, Palermo, Italy. .,I.R.C.C.S. Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS113, 98124, Messina, Italy. .,Hôpitaux Universitaires Beaujon, Radiology, Université Paris VII, Clichy, France. .,Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy.
| | - Diana Patti
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy
| | - Roberto Cannella
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy
| | - Giuseppe Salvaggio
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy
| | - Massimo Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy
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Ozawa M, Ichiyanagi O, Fujita S, Naito S, Fukuhara H, Suenaga S, Takai S, Narisawa T, Hosoya N, Ishii T, Yamanobe T, Muto A, Suzuki H, Nishida H, Kato T, Tsuchiya N. Risk of SOFA Deterioration in Conservative Treatment for Emphysematous Pyelonephritis: Pitfalls of Current Trends in Therapeutics from Multicenter Clinical Experience. Curr Urol 2019; 12:134-141. [PMID: 31316321 PMCID: PMC6613313 DOI: 10.1159/000489431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/20/2017] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION We investigated relationships between therapeutic outcomes of patients with emphysematous pyelonephritis (EPN) and changes in the Sequential Organ Failure Assessment (SOFA) score. MATERIALS AND METHODS We retrospectively evaluated EPN patients treated in our hospitals using the SOFA score incorporated in the Sepsis-3 updated in 2016. RESULTS Seventeen typical EPN patients were included in this study, and were treated with medical management with no drainage (n = 3), retrograde stenting (n = 10), or percutaneous drainage (n = 3). One patient without drainage died of sepsis, yielding an overall mortality rate of 5.9%. Twelve patients recovered without increase in the SOFA score during hospitalization. However, the SOFA score deteriorated in the other patients from admission, with the initial scores not significantly different from those of the 12 cases. The changes in the SOFA score were significantly affected by the selected approaches of drainage (100% patients for no drainage, 22% for stenting, and 0% for percutaneous drainage, p = 0.029), but not by other clinical data. CONCLUSION Most EPN patients can currently be conservatively managed successfully. However, it should be noted that less-invasive management could cause deterioration in SOFA after admission, yielding a risk of septic mortality.
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Affiliation(s)
- Michinobu Ozawa
- Department of Urology, Okitama Public General Hospital, Kawanishi, Japan
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Osamu Ichiyanagi
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Suguru Fujita
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
- Department of Urology, Nihonkai General Hospital, Yamagata, Japan
| | - Sei Naito
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroki Fukuhara
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
- Department of Urology, Nihonkai General Hospital, Yamagata, Japan
| | - Shinta Suenaga
- Department of Urology, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Japan
| | - Satoshi Takai
- Department of Urology, Okitama Public General Hospital, Kawanishi, Japan
| | - Takafumi Narisawa
- Department of Urology, Okitama Public General Hospital, Kawanishi, Japan
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Noriyuki Hosoya
- Department of Urology, Yamagata Prefectural Kahoku Hospital, Yamagata, Japan
| | - Tatsuya Ishii
- Department of Urology, South Miyagi Medical Center, Miyagi, Japan
- Department of Urology, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Takuya Yamanobe
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
- Department of Urology, Yamagata Prefectural Kahoku Hospital, Yamagata, Japan
| | - Akinori Muto
- Department of Urology, Yamagata Prefectural Shinjo Hospital, Shinjo, Japan
| | - Hitoshi Suzuki
- Department of Urology, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Hayato Nishida
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomoyuki Kato
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
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Jain A, Manikandan R, Dorairajan LN, Sreenivasan SK, Bokka S. Emphysematous pyelonephritis: Does a standard management algorithm and a prognostic scoring model optimize patient outcomes? Urol Ann 2019; 11:414-420. [PMID: 31649464 PMCID: PMC6798304 DOI: 10.4103/ua.ua_17_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: The objective of the study is to analyze the risk factors determining the outcomes of patients with emphysematous pyelonephritis (EPN) by the adoption of a standardized management algorithm as well as to develop a prognostic scoring model to risk stratify these patients. Materials and Methods: The hospital records of 72 consecutive patients with EPN from February 2012 to January 2018 were retrospectively reviewed. Demographic, clinicoradiographic, and laboratory characteristics were recorded. Patients were managed with a standard management protocol and based on outcomes divided into three groups. Group I survived with conservative management, Group II survived after emergency nephrectomy, and Group III expired. The risk factors for nephrectomy and mortality were analyzed. Results: The mean age was 53 years. Male to female ratio was 4:5. There were 61 (84.7%), 4 (5.6%), and 7 (10%) patients in Groups I, II, and III, respectively. Diabetes mellitus was the most common comorbidity detected in 62 (86%) of patients. Type II EPN was the most common radiological presentation observed in 32 (44%) patients. Overall survival rate was 90%, and kidney salvage rate was 80%. Escherichia coli was the most common organism isolated. Thirty-two (45%) patients exhibited resistance to third-generation cephalosporin antibiotics. Thrombocytopenia, low body mass index (BMI), presence of >2 comorbidities, high total leukocyte count (TLC), and hypoalbuminemia were significantly associated with mortality. On adoption of the prognostic scoring system, mortality rates according to the risk subgroups were as follows: favorable - 0%, intermediate - 19%, and poor - 100%. Conclusion: Conservative management adopting appropriate algorithm reduces mortality and avoids unnecessary emergency nephrectomies. Thrombocytopenia, low BMI, presence of >2 comorbidities, high TLC, and hypoalbuminemia were significantly associated with mortality.
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Affiliation(s)
- Amit Jain
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ramanitharan Manikandan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - Sriharsha Bokka
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Deoraj S, Zakharious F, Nasim A, Missouris C. Emphysematous pyelonephritis: outcomes of conservative management and literature review. BMJ Case Rep 2018; 2018:bcr-2018-225931. [PMID: 30209146 DOI: 10.1136/bcr-2018-225931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is a rare, necrotising infection of the renal parenchyma, predominantly associated with Escherichia coli infection and unless promptly recognised and dealt with, it carries a poor prognosis. The current treatment is one of antimicrobial therapies together with nephrectomy in a majority of patients. We report an elderly man with multiple comorbidities with a diagnosis of EPN whose condition improved with antimicrobial and supportive therapy, and no surgical intervention was required.
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Affiliation(s)
- Stuart Deoraj
- Department of Cardiology, Frimley Health Foundation Trust, Slough, Berkshire, UK
| | - Fady Zakharious
- Department of Cardiology, Frimley Health Foundation Trust, Slough, Berkshire, UK
| | - Ashraf Nasim
- Department of Cardiology, Frimley Health Foundation Trust, Slough, Berkshire, UK
| | - Constantinos Missouris
- Department of Cardiology, Frimley Health Foundation Trust, Slough, Berkshire, UK.,Medical School, University of Cyprus, Nicosia, Cyprus
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Bilateral emphysematous pyelonephritis cured by antibiotics alone in a black African woman. Radiol Case Rep 2018; 13:848-854. [PMID: 30002786 PMCID: PMC6040232 DOI: 10.1016/j.radcr.2018.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/24/2018] [Accepted: 05/26/2018] [Indexed: 12/27/2022] Open
Abstract
A 78-year-old black woman with a 10-year history of diabetes mellitus was admitted to the intensive care unit. Upon admission, she presented with chills, nausea, and left flank pain. The presence of hyperglycemia (fasting blood glucose, 19.7 mmol/L) and an altered consciousness required immediate treatment with insulin analog. Laboratory investigations and enhanced computed tomography scan led to the diagnosis of bilateral emphysematous pyelonephritis (EPN). The patient responded well to conservative treatment with antibiotics, and was finally discharged after 22 days when the computed tomography scan showed resolution of all the pockets of air. This case and associated literature review of 25 previously reported cases of bilateral EPN show the changing trend of EPN management from emergency nephrectomy toward conservative treatment with potent antibiotics and/or percutaneous drainage, and has been associated with higher survival rates compared to emergency nephrectomy.
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18
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Uscanga-Yépez J, González-Oyervides R, Barrera-Juárez E. Severe bilateral emphysematous pyelonephritis. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817720354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jaime Uscanga-Yépez
- Instituto Tecnológico de Estudios Superiores de Monterrey, Zambrano Hellion Medical Center, N.L. México
| | | | - Eduardo Barrera-Juárez
- Instituto Tecnológico de Estudios Superiores de Monterrey, Zambrano Hellion Medical Center, N.L. México
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19
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Kang CI, Kim J, Park DW, Kim BN, Ha US, Lee SJ, Yeo JK, Min SK, Lee H, Wie SH. Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections. Infect Chemother 2018; 50:67-100. [PMID: 29637759 PMCID: PMC5895837 DOI: 10.3947/ic.2018.50.1.67] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 02/06/2023] Open
Abstract
Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guidelines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs. The current guideline was developed by the update and adaptation method. This clinical practice guideline provides recommendations for the diagnosis and management of UTIs, including asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, complicated pyelonephritis related to urinary tract obstruction, and acute bacterial prostatitis. This guideline targets community-acquired UTIs occurring among adult patients. Healthcare-associated UTIs, catheter-associated UTIs, and infections in immunocompromised patients were not included in this guideline.
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Affiliation(s)
- Cheol In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jieun Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Baek Nam Kim
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Korea
| | - U Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jeong Kyun Yeo
- Department of Urology, Inje University College of Medicine, Pusan, Korea
| | - Seung Ki Min
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Heeyoung Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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20
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Deriving a management algorithm for emphysematous pyelonephritis: Can we rely on minimally invasive strategies or should we be opting for earlier nephrectomy? Int Urol Nephrol 2017; 49:2127-2136. [PMID: 28933020 DOI: 10.1007/s11255-017-1706-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/12/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE To analyse the incidence and management of emphysematous pyelonephritis (EPN) in North West London and examine factors that influence immediate and 6-month outcomes with the aim of guiding future management. METHODS This work analyses EPN cases from the London North West Healthcare NHS Trust from October 2006 to July 2015 (population ≈ 850,000). Diagnosis and stage were confirmed by computed tomography (CT). Demographic, clinical, biochemical and microbiological characteristics were assessed. Treatment modalities were medical management, minimally invasive management (MIM) and surgical. Immediate and 6-month outcomes were analysed. RESULTS Thirteen cases were identified (f = 8, m = 5) from 5525 CT scans. EPN occurred in patients with diabetes mellitus (n = 11, 84.6%), hypertension (n = 10, 76.9%) or urinary tract calculi (n = 7, 53.85%). Unilateral EPN occurred predominantly (n = 11, 84.6%); 46.1% (n = 6) were class 1 or 2 and 53.8% (n = 7) class 3 or 4. Escherichia coli was most commonly cultured (n = 5, 38.46%). All patients received antibiotics, and ten cases required MIM. Two patients had a delayed nephrectomy, both survived. Mortality was 15.4% (n = 2, grade 1 and 3a), both died acutely post-MIM, neither underwent emergency nephrectomy. At 6 months, eight patients had ongoing renal impairment. No specific poor prognostic factors were identifiable. CONCLUSIONS Patients with low-grade EPN may also have a high mortality rate. In the two cases who died, earlier consideration for nephrectomy may have been prudent. It may be beneficial to have a low threshold for prompt emergency nephrectomy in severe cases and where MIM treatment has failed. We suggest a management algorithm to guide clinicians and minimise mortality.
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21
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Sokhal AK, Kumar M, Purkait B, Jhanwar A, Singh K, Bansal A, Sankhwar S. Emphysematous pyelonephritis: Changing trend of clinical spectrum, pathogenesis, management and outcome. Turk J Urol 2017; 43:202-209. [PMID: 28717547 PMCID: PMC5503442 DOI: 10.5152/tud.2016.14227] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/01/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To highlight changing trend of clinical spectrum, comparing management options and predictors of outcome of emphysematous pyelonephritis. MATERIAL AND METHODS This study included patients who were diagnosed as emphysematous pyelonephritis between August, 2001 to July, 2015. We excluded other possible causes of gas in renal system. Baseline patient characteristics, clinical spectrum, serum and urinary biochemical parameters, radiological findings, management and outcomes were recorded. Patients were classified as "responders" and "non-responders". RESULTS We studied a total of 74 patients and categorised them as responders (62 patients) and non-responders (12 patients). Women outnumbered men constituting 62.16% of the study population (M: F; 1: 1.6). Fever was the most common presenting symptom followed by flank pain. Diabetes mellitus (85.14%) was the most common comorbidity followed by urolithiasis (32.43%). Escherichia coli was the commonest organism grown in urine culture (79.73%). Non-responders had distinct laboratory findings relative to responders as low hemoglobin (7.8±2.1/11.2±3.2 g/dL; p=0.0007), thrombocytopenia (91.67% vs. 11.29%; p=0.0001), proteinuria >3 g/L (50% vs. 6.45%; p=0.0008) and positive blood culture (100% vs. 67.74%; p=0.0288). CONCLUSION Advanced age, higher body mass index, renal impairment, thrombocytopenia, altered sensorium, shock at presentation can be used as scores for poor prognosis. Emphysematous pyelonephritis management requires multidisciplinary collaboration including hydration and electrolyte management, broad spectrum antibiotics, strict glycaemic control, effective urinary drainage and lastly it may require emergency nephrectomy as a salvage procedure.
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Affiliation(s)
- Ashok Kumar Sokhal
- Department of Urology, King George Medical University, Lucknow, U.p, India
| | - Manoj Kumar
- Department of Urology, King George Medical University, Lucknow, U.p, India
| | - Bimalesh Purkait
- Department of Urology, King George Medical University, Lucknow, U.p, India
| | - Ankur Jhanwar
- Department of Urology, King George Medical University, Lucknow, U.p, India
| | - Kawaljit Singh
- Department of Urology, King George Medical University, Lucknow, U.p, India
| | - Ankur Bansal
- Department of Urology, King George Medical University, Lucknow, U.p, India
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22
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Lu YC, Hong JH, Chiang BJ, Pong YH, Hsueh PR, Huang CY, Pu YS. Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis: 51 Cases and 14-Year-Experience of a Tertiary Referral Center. Medicine (Baltimore) 2016; 95:e3573. [PMID: 27227920 PMCID: PMC4902344 DOI: 10.1097/md.0000000000003573] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to investigate the profiles of pathogens and patterns of antibiotic resistance of emphysematous pyelonephritis (EPN), offering recommendations for initial antibiotic treatment.Between January, 2001, and November, 2014, demographic data, presenting clinical features, management strategies, and treatment outcomes of 51 patients with EPN were retrospectively reviewed, analyzing microbiological characteristics of causative pathogens and patterns of antibiotic resistance.Overall survival rate was 90.2% (46/51). Pathogens isolated most frequently were Escherichia coli (49.0%), Klebsiella pneumoniae (19.6%), and Proteus mirabilis (17.7%). Approximately 24% of E coli isolates and 22% K pneumoniae isolates were resistant to fluoroquinolones. Improper empiric antibiotic use (P = 0.02) and third-generation cephalosporin-resistant pathogens (G3CRP) (P = 0.01) were significantly more common in cases of patient fatality. Prior hospitalization and antibiotic use within past year (P = 0.03), need for emergency hemodialysis (P = 0.03), and development of disseminated intravascular coagulation (DIC) (P = 0.03) were factors correlating significantly with microbial resistance to third-generation cephalosporins. The area under the receiver operating characteristic curve was 0.91. The cut-off point determined by the maximum Youden index for 2 of these 3 factors yielded a sensitivity of 0.8 and specificity of 0.93.Third-generation cephalosporins are recommended as initial treatment of EPN. In patients with histories of prior hospitalization and antibiotic use and in those needing emergency hemodialysis or developing DIC, carbapenem is the empiric antibiotic of choice. Patients presenting with 2 or more factors carry the highest risk of G3CRP involvement. Fluoroquinolone and gentamicin should be avoided.
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Affiliation(s)
- Yu-Chuan Lu
- From the Department of Urology (Y-CL), National Taiwan University Hospital, Yunlin Branch ; Department of Urology (J-HH, B-JC, Y-HP, C-YH, Y-SP), National Taiwan University Hospital; Departments of Laboratory Medicine and Internal Medicine (P-RH), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Sun JN, Zhang BL, Yu HY, Wang B. Severe emphysematous pyelonephritis mimicking intestinal obstruction. Am J Emerg Med 2015; 33:1846.e3-6. [PMID: 25957142 DOI: 10.1016/j.ajem.2015.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/09/2015] [Indexed: 12/22/2022] Open
Abstract
Emphysematous pyelonephritis is a severe necrotizing infection characterized by the presence of gas and/or fluid in the renal parenchyma, collecting system, or perirenal tissues. Emphysematous pyelonephritis with approximately 15 cm air-fluid level, diffused ureteral involvement, and the accumulation of gas in liver and peritoneal cavity is very rare. Here, we reported a severe emphysematous pyelonephritis with multiple huge air-fluid level mimicking intestinal obstruction and with the accumulation of gas in liver and ureter in computed tomography imaging. The patient was successfully managed by percutaneous nephrostomy combined with medical treatment.
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Affiliation(s)
- Ji Ning Sun
- Shandong Medical Imaging Research Institute, Shandong University, No. 324, JingWu Road, Jinan 250021, Shandong, China; Department of Radiology, Weifang People's Hospital, No. 151, Guangwen Street, Kuiwen District, Weifang 261041, Shandong, China
| | - Bao Long Zhang
- Department of Radiology, Weifang Maternity and Child Care Hospital, No. 76, Qingnian Road, Weicheng District, Weifang 261011, Shandong, China
| | - Hai Yan Yu
- Department of Radiology, Weifang People's Hospital, No. 151, Guangwen Street, Kuiwen District, Weifang 261041, Shandong, China
| | - Bin Wang
- Binzhou Medical University, No. 346, Guanhai Road, Laishan District, Yantai 264003, Shandong, China.
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24
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Olvera-Posada D, Rodriguez-Covarrubias F. Reply by the authors. Urology 2014; 84:989. [PMID: 25260463 DOI: 10.1016/j.urology.2014.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/07/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Daniel Olvera-Posada
- Department of Urology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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