Hungarian Society of Urology

Emphysematous pyelonephritis, a special case of acute inflammation of the kidney

DOI: 10.22591/magyurol.2021.1.altennim.33

Altenni Mohammed dr., Zóber Tamás dr., Csapó Judit dr.,Beliczay Barbara dr., Vrecenár László dr., Buzogány István dr.
Péterfy KRMJOTI, Urológiai Sebészeti Osztály, Budapest (osztályvezető: Buzogány István dr.)


Introduction: Emphysematous pyelonephritis (EPN) is a rare, severe, and high-mortality acute infectious kidney disease. Due to its high mortality rate, it requires intensive therapy and broad-spectrum antibiotic treatment. After stabilization of cardiorespiratory functions of the patient, early intervention or surgery is recommended. Pathogens detected in the background include Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae group D Streptococcus and coagulase negative Staphylococcus, rarely a fungus (Candida albicans).
Patients and methods: From October 2017 to January 2020, 5 patients were treated in our ward for emphysematous pyelonephritis. Untreated hyperglycaemia was also detected in the majority of patients. In all cases, the lesion was diagnosed by a three-phase CT scan. Upon diagnosis, immediate, broad-spectrum antibiotic therapy and double-J catheter or transrenal drain insertion were performed, with explorative surgery if necessary. Two patients underwent unilateral nephrectomy and one patient dialysed due to chronic renal failure underwent bilateral nephrectomy. In our cases, no fatal outcome occurred.
Results: By presenting the case of a 53-year-old male patient, we would like to draw attention to the disease of emphysematous pyelonephritis. The examination of the patient revealed untreated diabetes, which was followed by its management, broad-spectrum antibiotic treatment and, a double-J catheter insertion for dilatation of the patient’s left renal system. As a result of interventions, the patient’s condition settled down and he left his home healed.
Conclusion: EPN is an extremely remarkable disease that occurs much more frequently than previously thought, and to this day is a deadly hazard to patients if not treated multidisciplinary and appropriately.


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