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Bilateral emphysematous pyelonephritis.

ABSTRACT: A 57-year-old man presenting with bilateral flank pain and hematuria was found to have severe bilateral emphysematous pyelonephritis. The patient was managed with a conservative approach consisting of systemic antimicrobials and decompression via percutaneous nephrostomy tubes with piperacillin-tazobactam instillations via nephrostomy and made a full recovery.

SUBMITTER: Hollingshead C

PROVIDER: S-EPMC7823199 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Bilateral emphysematous pyelonephritis.

Hollingshead Caitlyn C Luttmann Kelly K Georgescu Claudiu C

IDCases 20210114

A 57-year-old man presenting with bilateral flank pain and hematuria was found to have severe bilateral emphysematous pyelonephritis. The patient was managed with a conservative approach consisting of systemic antimicrobials and decompression via percutaneous nephrostomy tubes with piperacillin-tazobactam instillations via nephrostomy and made a full recovery. ...[more]

PMID: 33532239

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Project description:IntroductionEmphysematous pyelonephritis (EPN) is a severe form of life-threatening renal infection. Conservative treatment represents the gold standard in the management of EPN, but nephrectomy remains appropriate in certain situations.ObjectiveThe aim of our study was to report our experience in the conservative management of emphysematous pyelonephritis and to identify the predictive factors of failure of conservative treatment.Patients and methodsThis is a retrospective study including all patients treated for emphysematous pyelonephritis in our department between January 2015 and December 2020. The first-line treatment was conservative based on antibiotic therapy and drainage in case of an obstructive cause. A nephrectomy was performed in case of failure of the conservative approach. Epidemiological, clinical, biological, therapeutic, and evolutionary data were collected from the patients' files. Statistical analysis was made using SPSS version 28.Results41 patients were included in our study. The mean age was 64.4 years old [28-91] with gender ratio of 0.46 (13H/28F). Diabetes mellitus was present in 75.6% of cases. The mean presentation delay was 3.28 days (Kaiser and Fournier, 2005; Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007; Dutta et al., 2007; Dutta et al., 2007; Deoraj et al., 2018 Sep; Rahim et al., 2021 Mar; Maheshwari, 2021 Jul-Sep) [1-11]. In CT scan, 21 patients had class 1 EPN, 9 had class 2 EPN, 8 had class 3 EPN and 3 had class 4 EPN. The obstructive origin was found in 24 cases. Initially, 25 patients (60.9%) presented with severe sepsis and 7 patients (17.07%) developed a septic shock. Seven patients required nephrectomy with a mean delay of 2.12 days (Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007) [2-6]. Five patients with septic shock refractory to conservative treatment and two patients whose evolution was marked by the occurrence of secondary septic shock. In the univariate analysis, thrombocytopenia, initially septic shock, and the need for hemodialysis were the predictive factors of failure of conservative management in patients with emphysematous pyelonephritis.ConclusionEmphysematous pyelonephritis is a serious condition with significant mortality. The optimal management is based on conservative treatment in most cases. However, patients requiring hemodialysis and with thrombocytopenia and initially septic shock should be considered candidates for emergency nephrectomy.

Dataset Information

Bilateral emphysematous pyelonephritis.

Publications

Bilateral emphysematous pyelonephritis.

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