Case series to study the clinical features, risk factors, prognostic factors, and to assess the different management modalities of EPN and its outcomes

Background: Emphysematous pyelonephritis is an acute necrotising infection of the kidney, often associated with high rate of renal loss and mortality. EPN mostly present with triad of fever, flank pain and nausea. The diagnostic tool of choice is CT KUB. E. coli is the most common pathogen. Methods: It was prospective study done on 52 patients who were diagnosed to have EPN from department of nephrology and urology in Narayana Medical College, Nellore from March 2022 to January 2024. The diagnosis of EPN was confirmed by plain CT KUB scan. Results: Among 52 patients 48 patients had diabetes mellitus (DM). left kidney involved in 28 patients and right kidney involved in 16 patients and bilateral kidney involvement in 8. Fever (92%), flank pain (88%) are the most common presentation in patients. Shock during initial presentation was seen in 19.5% of patients. E. coli growth was seen in 26.9% cases. 8 patients were treated conservatively with antibiotics according to culture and sensitivity. 32 patients required double J stenting, 7 patients required percutaneous nephrostomy. Nephrectomy was done in 5 patients. Mortality rate in our study was zero. Conclusions: Nephrectomy should be promptly attempted for patients not responding to conservative methods. Pre-existing CKD status, shock at presentation and altered sensorium are the factors determining the prognosis and management.

Emphysematous pyelonephritis in patient with hemophagocytic lymphohistiocytosis: A case report

Emphysematous pyelonephritis (EPN) and hemophagocytic lymphohistiocytosis (HLH) are rare, fatal illnesses. The presence of both at once in a patient is extremely rare. The number of reported cases of EPN is <800 cases worldwide to date. Contrarily, the prevalence of adults with HLH is estimated to be 1 in every 2000 adults admitted to a tertiary health center. This case report aims to present the case of a 45-year-old woman who was diagnosed with EPN with a history of HLH and was successfully treated with medication alone. In conclusion, the clinical manifestations of EPN are non-specific and need imaging modalities like computed tomography (CT) scans. Treating EPN is based on CT scan classification. Medical treatment was an option for these patients. There is no direct association between EPN and HLH; it is a challenging decision to treat patients with both.

Pielonefritis enfisematosa / Emphysematous pyelonephritis

La pielonefritis enfisematosa es una enfermedad poco frecuente. Esta consiste en una infección necrotizante severa del parénquima renal asociada a formación de gas en el sistema colector, parénquima renal y/o tejidos perirrenales. Se presenta una paciente de 54 años de edad con antecedentes de diabetes mellitus tipo 2 no controlada y litiasis urinaria, atendida en el Cuerpo de Guardia del Hospital Celia Sánchez Manduley, Granma, Cuba. Presentaba náuseas y vómitos, dolor en ambos lados de la región lumbar, y fiebre. La ecografía mostró riñones hiperecogénicos e imágenes ecorefringentes en proyección de las cavidades renales. El cultivo de orina probó la presencia de escherichia coli, y se medicó de forma endovenosa. Por evolución no favorable, se realizó tomografía que evidenció patrón gaseoso en cavidades renales. Se reajustó la antibioticoterapia parenteral y la evolución fue favorable. Se dio alta de consulta, luego de 10 meses de seguimiento asintomática, con diagnóstico de pielonefritis enfisematosa(AU)

Emphysematous pyelonephritis is a rare disease, consisting of severe necrotizing infection of the renal parenchyma associated with gas formation in the collecting system, renal parenchyma and / or peri renal tissues. We report a 54-year-old patient with history of uncontrolled type 2 diabetes mellitus and urinary stones, she was treated in the emergency service at Celia Sánchez Manduley Hospital, Granma, Cuba. She had nausea and vomiting, pain on both sides of her lower back, and fever. Ultrasound showed hyper-echogenic kidneys and echo-refractive images in projection of the renal cavities. The urine culture proved the presence of Escherichia coli, and medications was administered intravenously. Due to the unfavorable evolution, a tomography was performed and it showed a gas pattern in the renal cavities. Parenteral antibiotic therapy was readjusted and the outcome was favorable. After 10 months of asymptomatic follow-up, she was discharged from the clinic with diagnosis of emphysematous pyelonephritis(AU)

Emphysematous pyelonephritis: is conservative management effective? Our experience and review of literature

Background: Emphysematous pyelonephritis (EPN) is a urologic emergency caused by a life-threatening necrotizing infection of the kidney leading to an accumulation of gas in the renal parenchyma and perirenal tissue. we present the clinical details and outcome of twelve patients of managed at our institute and discuss their management and outcomes.Methods: Twelve consecutive patients with EPN were managed in our institute from July 2014 to July 2018. Data on demographic profile, clinical features, laboratory investigations, imaging studies, outcome of patients and follow up details were recorded.Results: Out of 12 patients with EPN, nine were female and three were male. Ten patients were diabetic (83%). All the diabetic patient had raised blood sugar at the time of admission ureteric stone was present in two nondiabetic patients. All the patients had fever at the time of presentation while localized flank pain was present in 6 (50%) patients. On examination, renal angle tenderness was present in ten patients while abdominal mass found in three patients. Pyuria was found in all patients while leukocytosis found in 10 patients. Two patients had thrombocytopenia while 4 had deranged renal parameters at the time of admission. Urine culture showed Escherichia coli in 8 patients and Klebsiella in two patients. Four patients required percutaneous drainage. Interval nephrectomy was done in one patient due to non-functioning kidney.Conclusions: Majority of patients diagnosed as emphysematous pyelonephritis were managed conservatively due to diagnosed at an early stage. Percutaneous drainage is successfully utilized in patients with more advanced disease.

A patient with emphysematous pyelonephritis presenting with acute kidney injury: A case report / Lao Medical Journal

@#Emphysematous Pyelonephritis (EPN) is an uncommon but life-threatening condition for which diabetic patients are at high risk. The most common chief complaint bringing patients to the hospital is upper urinary tract infection. Early clinical diagnosis with radiography is a key to reduce the complications and death due to emphysematous pyelonephritis. We present a case study of a 45-year old female patient who was presenting to the emergency room with left flank pain. Blood testing showed acute kidney injury, E. coli bacteremia, and the radiography demonstrated an abnormal image of the left kidney consistent with EPN. Symptomatic treatment and antibiotic were given, but no response and developed to heart failure and death at Emergency Room.

A clinical study of emphysematous pyelonephritis

Background: Emphysematous pyelonephritis should be suspected in every diabetic patient, presenting with features of acute pyelonephritis. E.coli is the most common organism associated with EPN. Aim: To study the clinical features, radiological classification and risk factors assess the prognostic factors and to study different management modalities of Emphysematous pyelonephritis and their outcomes. Materials and methods: It was prospective study done on 48 patients who were diagnosed to have Emphysematous pyelonephritis from various departments in Osmania General Hospital from October 2004 to October 2006 were included in the study. The diagnosis of EPN was confirmed by plain CT KUB scan. Results: All the 48 patients with EPN had diabetes mellitus (DM). All the 48 patients had poorly controlled DM. Left kidney was involved in 54.1% and Right kidney in 37.5% of cases. 6.25% of cases had bilateral involvement. Fever (93%) and tachycardia (64.5%) were most common presentation in patients. Thrombocytopenia was seen in 50% of these patients and 12% of patients with thrombocytopenia required platelet transfusion. Shock during initial presentation was seen in 22.9% of patients. 16.6% of patients presented with altered sensorium. E.coli was grown in 78% of patients and klebsiella in 6% of patients. There were 6 patients with dry EPN and 42 patients with wet EPN. 41.6% of patients had Class 2 EPN (Commonest class in our study), 25% of patients had class 3A EPN, 22.9% had Class 1 EPN, 6.25 had Class 4 EPN. 15.63% of patients were treated conservatively with antibiotics according to culture and sensitivity. 78% of patients required minimally invasive intervention. Nephrectomy was done in 6% of patients. Mortality rate in our study was 8.3%. V. Vishnu Vardhana Reddy, K. Panduranga Rao. A clinical study of emphysematous pyelonephritis. IAIM, 2018; 5(2): 150- 159. Page 151 Conclusions: Nephrectomy should be promptly attempted for patients not responding to conservative methods and patients with extensive, fulminant course of disease. Pre-existing CKD status, shock at presentation and altered sensorium are the poor prognostic factors in this study.

Pielonefritis enfisematosa en paciente con infección por virus de inmunodeficiencia humana: reporte de caso / Emphysematous pyelonephritis in patient with human immunodeficiency virus infection: A case report

La pielonefritis enfisematosa es una infección necrosante del parénquima renal que puede afectar los tejidos perirrenales y cuyo espectro de presentación clínica, por esa razón, es variable (choque séptico, acidosis metabólica, hiperglucemia, hipoglucemia, falla renal, delirio, entre otros); la mayoría de los casos se han informado en pacientes con diabetes mellitus o presencia de uropatía obstructiva. Reportamos el caso de una paciente joven no diabética quien presentó pielonefritis enfisematosa como condición clínica que lleva al diagnóstico inicial de infección por VIH, sin otras comorbilidades relacionadas, exitosamente tratada con manejo quirúrgico y antibioticoterapia. Se realizó una búsqueda sistemática de la literatura, en la cual no se ha informado esta enfermedad como manifestación clínica que lleve al diagnóstico inicial de la infección por VIH.

Emphysematous pyelonephritis is a necrotising infection of the renal parenchyma that may affect the perirenal tissue. Thus, the spectrum of clinical presentation is variable (septic shock, metabolic acidosis, hyperglycaemia, hypoglycaemia, renal failure, delirium); most cases have been reported in patients with diabetes mellitus or obstructive uropathy. We report the case of a young female patient without diabetes who presented emphysematous pyelonephritis as the condition that led to the diagnosis of HIV infection, without related comorbidities, and who was successfully treated with surgical and antibiotical therapy. A systematic search of the literature revealed that this disease as a condition leading to an initial diagnosis of HIV infection has not been previously reported.

Asymptomatic Emphysematous Pyelonephritis Incidentally Detected with Computed Tomography in a Diabetic Hemodialysis Patient / 대한내과학회지

Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney with gas formation that can be fatal if it is not detected and treated promptly. Typical manifestations are high fever, flank pain, and shock. It typically occurs in patients with diabetes and, although rarely reported, in hemodialysis (HD) patients with or without diabetes. Furthermore, asymptomatic EPN has not yet been reported in HD patients. Here, we report a case of asymptomatic EPN in a diabetic HD patient incidentally detected with follow-up abdominal computed tomography after resection of colon cancer.

Emphysematous pyelonephritis: non surgical treatment approach.

Emphysematous pyelonephritis is a severe infection characterized by the presence of gas within the renal parenchyma tissues. It is a life threatening complication of bacterial interstitial nephritis, and it mainly occurs in patients with diabetes mellitus. We report a case of a 37 year old female who complained of fever and pain in left lumbar region on admission. Her past medical history included uncontrolled type 2 diabetes mellitus. On USG (ultrasonography), left kidney swollen and show echogenic linear specs with dirty shadowing suggestive of air in pelvicalyceal system (PCS). She was treated with intensive antibiotic therapy in high doses. On repeat USG there was marked reduction in air shadow in kidney and patient improved clinically.

Emphysematous Pyelonephritis in a 32-Year-Old Diabetic Female.

Emphysematous pyelonephritis is a rare, severe, necrotizing renal parenchymal infection characterized by gas accumulation in kidney(s) with or without involving surrounding tissues. Patients with diabetes mellitus are the usual sufferers. Here we describe a case history of a young Bangladeshi diabetic lady who presented with dysuria, fever and abdominal pain. Investigations confirmed left sided emphysematous pyelonephritis. She responded to and recovered with intravenous antibiotics.

A Case of Incidentally Detected Asymptomatic Emphysematous Pyelonephritis / 대한내과학회지

Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of the renal parenchyma and surrounding tissues. Patients with EPN commonly present with high fever, chills, and flank pain. These symptoms mimic a simple urinary tract infection, such that diagnosis is often delayed. Because of its life-threatening fulminant course, the early detection of EPN and its prompt treatment with intravenous antibiotics with or without percutaneous drainage are critical. Here we describe a case of a 63-year-old Korean female with diabetes mellitus who had no specific symptoms or signs of EPN. A chest computed tomography (CT) scan to assess a right pleural effusion incidentally detected an abnormal gas shadow in the renal parenchyma. An abdominal CT scan performed 5 days later showed increased gas within the kidney parenchyma, but the patient still had no symptoms of EPN. She was treated with intravenous antibiotics alone. A follow-up abdominal CT scan revealed the complete disappearance of the features of EPN.

Fever with abdominal pain and diabetes - Is it Emphysematous Pyelonephritis?

Emphysematous pyelonephritis (EPN) is a rare, severe infection of renal parenchyma presenting commonly with fever and flank pain and presence of gas in the renal and/or peri-renal space. EPN can be life threatening if not diagnosed and treated promptly. Air shadows in the renal or peri-renal region on imaging studies of the abdomen are diagnostic features of EPN. However, computed tomography (CT) scan of the abdomen is better than ultrasound for diagnostic classification, prognosis, and treatment options. We treated a young female with uncontrolled type II diabetes mellitus who had severe abdominal and back pain with fever. The CT scan confirmed the diagnosis of EPN. The conservative treatment itself was effective in complete resolution of the disease even though patient had severe type of EPN.

Emphysematous Pyelonephritis: Radiological Perspective.

Emphysematous pyelonephritis (EPN) is an acute necrotizing parenchymal and perirenal infection and is caused by gas-forming organisms. Diabetes mellitus and ureteric obstruction are the predisposing factors for EPN. Computerized tomography (CT) scan is the modality of choice in diagnosing the disease, determining the extent of infection and helps in management. We report a case of emphysematous pyelonephritis in 52 years old man with emphasis on plain radiographic and CT scan findings.

Emphysematous Pyelonephritis Caused by Citrobacter freundii in a Patient with Type 2 Diabetes and Neurogenic Bladder / 감염과화학요법

Emphysematous pyelonephritis (EPN) is a rare, life-threatening complication of upper urinary tract infections that is characterized by the presence of gas in the renal parenchyma and perirenal space. It commonly occurs in diabetic patients. Escherichia coli are the most common causative organisms, with few reports implicating Citrobacter freundii as the etiologic agent in EPN. A 57-year-old woman with diabetes and neurogenic bladder visited at our department with confused mentality, myalgia, and general weakness. Further investigation revealed that the patient suffered from unilateral EPN with sepsis caused by C. freundii. The patient's condition was improved considerably with percutaneous drainage and use of intravenous antibiotics for several weeks. However, renal function eventually deteriorated to permanent renal failure, which required hemodialysis. In conclusion, C. freundii may be the causative pathogen of EPN in a patient with type 2 diabetes and neurogenic bladder.

Emphysematous pyelonephritis in a diabetic leading to renaldestruction: pathological aspects of a rare case

Emphysematous pyelonephritis is a severe, potentially fatal necrotizing pyelonephritis with a variable clinical presentation, ranging from mild abdominal pain to septic shock. The majority of cases occur in diabetics with poor glycemic control, while a small percentage may be due to urinary tract obstruction. We present a case of a 57 year old male patient, diabetic on treatment, presenting with left fl ank pain and poor stream of urine since one week. Laboratory tests revealed that the patient had electrolyte imbalance, ketoacidosis and high blood sugar. Urine culture was positive for Escherichia coli with a signifi cant colony count. Radiological examination gave a diagnosis of Left Type 1 Emphysematous Pyelonephritis. Inspite of giving vigorous resuscitation and antibiotics with nephrostomy, the patient had to undergo nephrectomy due to extensive renal parenchymal destruction. The nephrectomy specimen was studied in detail to know the histopathological fi ndings in a case of diabetic patient with emphysematous pyelonephritis. We present this case not only because of it being a rare complication of diabetes, but also to focus on the histopathological fi ndings of the same, documentation of which is limited in literature.

Pielonefritis, colecistitis y cistitis enfisematosas en paciente con diabetes mellitus descompensada / Pyelonephritis, cholecystitis, and emphysematous cystitis in a diabetic patient

Background. Emphysematous pyelonephritis is a necrotizing infection characterized by gas production that usually is located in the kidney tissue, urinary tract and retroperitoneal tissue. Gas can escape following the renal veins and accumulate in the hepatic veins and other places. E coli is the most common causative organism. Clinical case: We report a 62 years old diabetic female, admitted to the hospital with a diabetic ketoacidosis. An abdominal CT scan disclosed a left emphysematous pyelonephritis, cholecystitis and cystitis. The patient was operated, performing a left nephrectomy, cholecystectomy and placement of sub hepatic and retroperitoneal drainages. The pathological study of the surgical piece showed an acute pyelonephritis with abscess formation and chronic cholecystitis. The patient died due to a multi systemic failure.

Introducción: La Pielonefritis enfisematosa es una infección necrotizante caracterizada por la producción de gas, que habitualmente se ubica en el parénquima renal, las vías urinarias y los tejidos retroperi-toneales. Cuando el gas es abundante puede escapar siguiendo las venas renales y acumularse en las venas hepáticas, y el resto del sistema. La E. coli es el patógeno más frecuente. Caso clínico: Presentamos el caso de paciente femenina de 62 años, diabética que ingresa con sintomatología de vías urinarias diagnosticada como pielonefritis enfisematosa izquierda por tomografía y encontrando como hallazgos adicionales.

Synchronus Emphysematous Pyelonephritis and Emphysematous Cystitis - A Rare Clinical Entity.

Concomitant emphysematous pyelonephritis (EP) and emphysematous cystitis (EC), is a rare potentially life-threatening condition.The Current case report stress upon the early detection and appropriate treatment of emphysematous pyelonephritis and emphysematous cystitis , to avoid the potential morbidity and mortality associated with this infection.

Clinical Feature and Prognostic Factors of Emphysematous Pyelonephritis / 대한구급학회지

BACKGROUND: Emphysematous pyelonephritis (EPN) is a rare and potentially life-threatening condition that requires prompt evaluation and management. However, its clinical presentation and outcomes vary widely. This study was conducted to ascertain the clinical features and prognostic factors regarding EPN. METHODS: All patients diagnosed with EPN radiologically and treated at the emergency department in the university-affiliated, tertiary-referral center, from January 1999 to December 2009 were evaluated. The patients' demographic and clinical characteristics, computed tomographic findings, treatment, and outcomes were analyzed retrospectively. RESULTS: Overall 14 patients diagnosed with EPN were admitted. There were 12 females and 2 males. A history of diabetes was found in 12 (85.7%) patients and was the most common comorbidity. The chief complaint among patients was flank pain (42.9%). Severe sepsis or septic shock was noted in 10 (71.4%) patients. Thirteen cases had unilateral involvement and one case had bilateral involvement. More than half of patients had Escherichia.coli in culture. Mean serum levels of HbA1c, creatinine, C-reactive protein (CRP) were 9.4 +/- 2.7, 2.4 +/- 1.4 mg/dl, and 22.4 +/- 13.1 mg/dl. Eight (57.1%) patients received antibiotic treatment alone and four (28.6%) patients received the concurrent percutaneous drainage as well as antibiotics. Hospital mortality was 7.1%. A higher initial serum CRP level (20.3 vs. 49.8 mg/dl, p = 0.02) and HbA1c level (8.7 vs. 16.4, p = 0.01) was associated with hospital mortality. CONCLUSIONS: Antibiotics alone provide a high success rate for the treatment of EPN. Higher serum CRP and HbA1c level was associated with a higher mortality rate in patients with EPN.

A Case of Emphysematous Pyelonephritis Associated with Emphysematous Ureteritis and Cystitis

Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma and its surrounding tissues that results in the accumulation of gas in the renal parenchyma, collecting system or perinephric tissue. EPN is a potentially life-threatening condition, which is most commonly associated with poorly controlled diabetes. We describe a case of emphysematous pyelonephritis associated with emphysematous ureteritis and cystitis in a 68-year-old diabetic woman, who was cured with medical treatment and surgical intervention.