Emphysematous pyelonephritis

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Background

  • Rare gas-forming infection nearly always occurring in patients with DM and obstruction
    • Patients appear toxic and septic; nephrectomy may be required

Clinical Features[1]

Differential Diagnosis

Dysuria

Evaluation

Labs

  • CBC with high WBC, low platelets
  • Urinalysis with urine culture
  • Creatinine
  • Blood culture

Imaging

  • CT is definitive
  • Staging[2]:
    • Class 1 - gas confined to collecting system
    • Class 2 - gas confined to renal parenchyma alone
    • Class 3A - perinephric extension of gas or abscess
    • Class 3B - extension of gas beyond Gerota fascia
    • Class 4 - bilateral or EPN in solitary kidney

Management

  • IVF
  • Antibiotics

Disposition[3]

  • Poor prognostic risk factors:
    • Creatinine > 1.4mg/dL
    • Platelets < 60k
    • Altered mental status
    • Shock
  • Urological consult for percutaneous drainage, stent placement, or nephrectomy (classes 3 and 4 with 2 or more prognostic risk factors)
  • Presence of obstructive stone requires even more urgent surgical intervention
  • Mortality rates between ~20-40%

See Also

External Links

References

  1. Tang HJ, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001 Jun. 34(2):125-30.
  2. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000 Mar 27. 160(6):797-805.
  3. Shetty S et al. Emphysematous Pyelonephritis Treatment & Management. eMedicine. Apr 11, 2014. http://emedicine.medscape.com/article/457306-treatment#showall.