Outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis.
OBJECTIVE
Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of the kidney characterized by gas formation. In order to compare the outcome of nephrectomy and kidney-preserving procedures for the treatment of EPN we reviewed our experiences of EPN over the past 18 years.


METHODS
The medical records of 17 patients with EPN treated between October 1986 and September 2004 were retrospectively reviewed. Abdominal X-ray and/or CT were used as diagnostic methods.


RESULTS
Women outnumbered men (12 vs five), and all patients had diabetes. Obstruction of the corresponding reno-ureteral unit was found in one patient. Thirteen of the 17 patients (76%) had poorly controlled diabetes (hemoglobin A1c>7%). The diagnosis of EPN was confirmed by gas in the parenchymal or perinephric space as detected by abdominal X-ray or CT. Escherichia coli was the commonest organism present in urine cultures (52%), followed by Klebsiella pneumoniae (24%). Prompt efforts were made to control diabetes, and i.v. antibiotics were given. Nephrectomy was performed in 10 patients and nine patients survived (90% success rate). The success rate among those who received medical therapy only was 50% (2/4 patients). Percutaneous drainage was performed in three patients, two of whom survived (67% success rate). The overall mortality rate was 17.6% (3/17 patients).


CONCLUSIONS
Immediate nephrectomy with glycemic control measures and antibiotic administration is crucial for the successful treatment of EPN. However, in inoperable cases, percutaneous drainage can be an effective treatment option.
Park
Bum Soo
BS
Department of Urology, School of Medicine, Kyung Hee University, Seoul, South Korea.
Lee
Sun-Ju
SJ
Kim
Youn Wha
YW
Huh
Jung Sik
JS
Kim
Jin Il
JI
Chang
Sung-Goo
SG
D000328:Adult; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001769:Blood / Q000382:microbiology; D019468:Disease Management; D024881:Drug Resistance, Bacterial; D004646:Emphysema / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011704:Pyelonephritis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014556:Urine / Q000382:microbiology
D000900:Anti-Bacterial Agents