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Emphysematous Pyelonephritis

Created: 9/1/2006

 

Emphysematous Pyelonephritis

 

Definition

A life-threatening, fulminant, necrotising upper urinary tract infection associated with gas within the kidney and/or perinephric space

NB. Gas confined to the renal pelvis should be called emphysematous pyelitis

 

Epidemiology

Male to female 1:2

Mean age 54 years

Mortality up to 80%

EPN is bilateral in 5-7% patients

 

Aetiological Risk Factors

Diabetes mellitus (up to 90%)

Obstructive uropathy

Urinary calculi

Calyceal stenosis

Neoplasms

 

Signs and symptoms

Pyrexia, rigors, flank/loin pain, lethargy, and confusion not responding to treatment

PUO (18% of patients)

Septicaemic shock and abdominal symptoms are less common manifestations

Crepitant mass may be present

Bacteriuria, positive blood culture and leukocytosis are often present

 

KUB

Air in the renal collecting system





IVU

Renal enlargement with delayed or absent excretion

 

CT (examination of choice)

Intraparenchymal, intracalyceal, and intrapelvic gas and extension into perinephric space are readily identified on nonenhanced CT scans

Mottled areas of low attenuation extend radially along the pyramids

Pus may be seen extending into the renal veins

 

Differential diagnosis

Retroperitoneal perforation of an abdominal viscus

Psoas abscess secondary to gas-forming organisms

Reflux of air from the bladder

Bronchorenal, enterorenal, or cutaneorenal fistulae

Air in a focal renal abscess (not life threatening)

 

Treatment

Most patients require immediate surgical intervention

Aggressive antibiotic therapy,

Drainage procedures to relieve obstruction

Prompt nephrectomy in life-threatening situations


ArticleDate:20060109
SiteSection: Article
 
   
    
                                            



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