Emphysematous pyelonephritis. Epidemiological, clinical, biological, bacteriological, radiological, therapeutic and prognostic features. Retrospective study of 30 cases.

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Mohamed Cherif
Walid Kerkeni
Abderrazak Bouzouita
Mohamed Slim Selmi
Amine Derouiche
Mohamed Riadh Ben Slama
Mohamed Chebil

Abstract

Background : Emphysematous pyelonephritis is an uncommon, necrotizing bacterial infection of the kidney. It is a severe, lifethreatening affection.
Aims: To study the epidemiological, clinical, biological, bacteriological and radiological features of this affection, and to describe its therapeutic management and prognostic characteristics.
Methods: We conducted a retrospective study including 30 patients who were treated for an emphysematous pyelonephritis, in Charles Nicolle hospital department of urology, from 1987 to 2009.
Results: Emphysematous pyelonephritis generally affects adults. It is especially favored by diabetes and urinary tract obstruction. Escherichia coli is the main causative agent. Uroscan is the key of diagnosis. It is both medical and surgical emergency; the treatment combines intensive care with appropriate antibiotics and often drainage. Nephrectomy may be necessary from the outset, or after drainage failure. Prognosis is poor, with a high mortality rate (23 %), in our series.
Conclusion: Management of emphysematous pyelonephritis poses real problems. This affection is still threatening, despite of advances in intensive care.

Keywords:

Antibiotics; drainage; emphysema; pyelonephritis; surgery

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References

  1. E.Kaiser, R.Fournier. Pyélonéphrite emphysémateuse : diagnostic et traitement. Encyclopédie médico-chirurgicale. Urologie. 2005 Elsevier.
  2. Wan Y, Lo SK, Bullard M, Chang P, Lee T. Predictors of outcome in emphysematous pyelonephritis. J Urol 1998; 159:369-73.
  3. Pagnoux C, Cazaala JB, Mejean A, et al. Pyélonéphrite emphysémateuse chez le diabétique. Rev Med Intern 1997; 18:888-92.
  4. Hansmann Y, Lecuyer S, Belhamou S, Christman D. La pyélonéphrite emphysémateuse. Ann Med Interne 1988; 149:326-30.
  5. Chen KW, Huang J, Wu M, Lin X, Chen CH. Gas in hepatic veins: a rare and critical presentation of emphysematous pyelonephritis. J Urol 1994; 151:125-6.
  6. Michaeli J, Mogle D, Perlberg S, Heiman S, Caine M. Emphysematous pyelonephritis. J Urol 1984; 131:203-8.
  7. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinico radiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000; 160:797-805.
  8. Pappas S, Peppas T, Sotiropoulos A, Katsadoros D. Emphysematous pyelonephritis: a case report and review of the literature. Diabet Med 1993; 10:574-6.
  9. Kupeli S, Beduk Y, Yaman S, Safak M. Emphysematous pyelonephritis with pneumocystitis. Urol Int 1988; 43:318-20.
  10. Corr J, Gleeson M, Wilson G, Grainge R. Per cutaneous management of emphysematous pyelonephritis. Br J Urol 1993; 7:487-8.
  11. Mianne D, Beatrix O, Bregion M, Sabdah P, Altobelli A, Boyer C. Pyélonéphrite emphysémateuse. Complication rare du diabète sucré. Med Armees 1996 ; 24 :583-6.
  12. Mchugh TD, Albanna S, Stewart N. Bilateral emphysematous pyelonephritis. Am J Emrg Med 1998; 16:166-9.
  13. Stein JP, Spitz A, Elmajian DA, et al. Bilateral emphysematous pyelonephritis: a case report and review of the literature. Urology 1996; 47:129-34.
  14. Evanoff GV, Thompson CS, Foley R, Weinmann EJ. Spectrum of gas within the kidney. Emphysematous pyelonephritis and emphysematous pyelitis. Am Med 1987; 83:149-54.
  15. Tligui M, Chelbi N, Nouri M, Haab F, Gattegno B, Thibault P. Emphysematous pyelonephritis: apropos of a case and review of the literature. Prog Urol 1999; 9:739-41.
  16. Ahlering TE, Boyd SD, Hamilton CL, et al. Emphysematous pyelonephritis: a 5-year experience with 13 patients. J Urol 1985; 134:1086-8.
  17. Lim CS, Kim WBY, Kim YS, Ahn C. Bilateral emphysematous pyelonephritis. J Nephrol 2000; 13:155-8.
  18. Huang JJ, Chen KW, Ruaan MK, Tsai HM. Recurrent emphysematous pyelonephritis. A case report. Int Urol Nephrol 1994; 26:389-93.
  19. Valles J, Leon C, Alvarez-Lerma F. Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Clin Infect Dis 1997; 24:387-95.
  20. Mydlo JH, Maybee GJ, Ali-Khan MM. Percutaneous drainage and/or nephrectomy in the treatment of emphysematous pyelonephritis. Urol Int 2003; 70:147-50.
  21. A Derouiche, A Ouni, A Agrebi, A Slama, M R Slama, M Chebil. La prise en charge de la pyélonéphrite emphysémateuse. A propos de 21 cas. Prog Urol 2008;18:102-7.
  22. Chen MT, Huang CN, Chou YH, Huang CH, Chiang CP, Liu GC. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience. J Urol 1997; 157:1569-73.