Treatment of emphysematous pyelonephritis with broad-spectrum antibacterials and percutaneous renal drainage: an analysis of 10 patients.
BACKGROUND
This retrospective study was designed to determine the efficacy of broad-spectrum antibacterials combined with percutaneous renal drainage in the treatment of emphysematous pyelonephritis (EPN).


METHODS
From July 1992 to September 2002, 10 patients (nine females and one male) with EPN were managed at our institution. All patients had diabetes and presented with fever and chills, flank pain or tenderness, vomiting, and altered consciousness. The diagnosis of EPN was confirmed by the presence of intraparenchymal and/or perinephric gas in imaging studies (kidney-ureter-bladder film, sonogram, and/or computed tomography scan). Broad-spectrum antibacterial therapy, combined with percutaneous renal drainage, was started in all patients. Follow-up studies consisted of computed tomography scan and technetium-labeled diethylenetriaminepentaacetic acid (DTPA) radioisotope renography.


RESULTS
The outcome was good in all patients. Three patients underwent delayed nephrectomy due to non-functioning of the involved kidney. The DTPA radioisotope renography results (glomerular filtration rate of the diseased kidney/ contralateral healthy kidney) were 0/57 mL/min, 2.7/68.1 mL/min and 3.7/63.9 mL/min.


CONCLUSIONS
Combined broad-spectrum antibacterial therapy and percutaneous renal drainage is a safe and effective treatment for EPN, especially in high-risk patients for whom nephrectomy under general anesthesia is not feasible.
Chan
Pei-Hui
PH
Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC. surgery@mail.femh.org.tw
Kho
Victor Ka-Siong
VK
Lai
Siu-Kei
SK
Yang
Ching-Hwa
CH
Chang
Hsiao-Chun
HC
Chiu
Bin
B
Tseng
Shei-Chain
SC
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011704:Pyelonephritis / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D012189:Retrospective Studies; D013396:Suction; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents