Clinical profile and outcome of emphysematous pyelonephritis presenting to a tertiary care hospital

Abstract

Abstract Background Emphysematous pyelonephritis is a necrotizing infection of the renal parenchyma by gas-forming organisms. The diagnosis of emphysematous pyelonephritis is made by clinical features and the detection of air in the renal parenchyma. In the past, nephrectomy was considered the only treatment option with a high mortality rate, but with advances in minimally invasive conservative techniques and better antibiotic treatment, the rate of kidney salvage has increased. Case presentation From January 2019 to December 2022, eight cases of emphysematous pyelonephritis were diagnosed based on clinical features and documentation of gas in the renal parenchyma by a Computed tomography scan. The mean age was 61.75 ± 4.3 years. 62.5% were female and 75% were diabetics. E. coli was the most common pathogen (87.5%). All 8 patients underwent early interventions in the form of DJ stenting or percutaneous nephrostomy tube insertion with only one patient requiring nephrectomy without any immediate mortality. Conclusion Emphysematous pyelonephritis is more common in women and the elderly. Diabetes mellitus and nephrolithiasis are major risk factors. E. coli was the most frequently isolated pathogen. Early diagnosis and early minimally invasive intervention in the form of a DJ stenting or percutaneous nephrostomy reduced the rate of nephrectomy and mortality.

Keywords

• Emphysematous pyelonephritis
• Urinary tract infection
• Obstructive nephropathy
• Diabetic kidney disease