A Review of Acute Emphysematous Pyelonephritis

Sohn,  Houng Gyu

J Korean Soc Emerg Med > Volume 12(1); 2001 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2001;12(1): 74-83.

A Review of Acute Emphysematous Pyelonephritis

Houng Gyu Sohn

Department of Urology, College of Medicine, Dongguk University, Korea. tenmu@hitel.net

ABSTRACT

BACKGROUND: Acute emphysematous pyelonephritis is rare, severe, acute bacterial infection of the kidney characterized by the presence of gas within the renal parenchyma, collecting system or perinephric tissue and requires the emergent intensive treatment. Diagnosis is usually established by the certain radiologic findings. Mortality rates of patients reportedly vary from 40 to 90% and patients treated conservatively approaches 80% in some series. Traditional therapy for emphysematous pyelonephritis is nephrectomy. Recent advances on endourologic area have been applied to percutaneous drainage, but appropriate care requires aggressive treatment to preserve renal function without increased mortality. I reviewed the clinical feature, radiologic findings and results of different mode of treatments. METHOD AND
RESULTS:
Seven patients who admitted with the impression of the acute emphysematous pyelonephritis from March 1997 to March 1999 were enrolled in this study. The clinical feature, radiologic findings and results of different treatments were evaluated. All patient presented with diabetes mellitus and complained fever of short duration. Other characteristics and laboratory findings were variable. Escherichia coli was documented organism in 4 cases and Klebsiella in 1 case. Of the 7 patient, 4 were managed by conservative treatment including with intensive antibiotic therapy followed by prolonged oral antibiotics and supportive care. The results of treatment of 3 cases were successful but, 1 patient with multiple predisposing diseases and poor general condition at the initial presentation was deteriorated despite of intensive care. And among the 7 cases, emergent nephrectomy was performed to 2 patients, as the patient had the evidence of progressive course of septic shock and clinically fetal. After operation, 2 patients improved markedly. And remaining 1 patients were improved after the percutaneous drainage of the collection of prominent perirenal abscess.
CONCLUSION:
Tough definite prognostic factor were not documented, the underlying disease and general condition in initial presentation may have important role. Standard treatment to emphysematous pyelonephritis are known to be emergent nephrectomy, but my cases revealed that conservative treatment including intensive antibiotics therapy and percutaneous drainage may effective to the less critical patients.

Key words: Emphysematous pyelonephritis, Conservative therapy, Nephrectomy