Presentation and outcome of emphysematous renal tract disease in patients with diabetes mellitus.
BACKGROUND
Emphysematous renal tract disease (ERTD) is a rare necrotizing infection of the renal parenchyma and urinary tract caused by gas-producing organisms. ERTD deserves special attention because of its life-threatening potential.


OBJECTIVE
To study the clinical features, radiological classification and prognostic factors of ERTD; and to compare the modalities of management and the outcome among the various radiological classes of ERTD.


METHODS
Twenty consecutive patients with diabetes and ERTD, seen over last 3 years in a tertiary care institute of north India, were included in the study. All patients were subjected to computerized tomography (CT) after initial diagnosis by ultrasonography. They were classified into 5 classes as previously described. All patients included in the study were conservatively managed with appropriate antibiotics and/or percutaneous drainage or surgery if required.


RESULTS
Mean age (+/- SD) of these subjects was 54.4 +/- 20.6 years; duration of diabetes mellitus 8.6 +/- 5.8 years, and duration of symptoms related with ERTD ranged from 3 days to 3 months. Two patients had isolated emphysematous cystitis, 13 patients had emphysematous pyelonephritis (EPN), 3 had both EPN and cystitis, and 1 patient had EPN with cholecystitis, and 1 patient had EPN with pyomyositis. Only 7 (35%) patients had a history of pneumaturia. Escherichia coli was the commonest microorganism. The radiological distribution in 18 (2 had isolated cystitis) patients with EPN was: 2 patients had class 1; 1 had class 2; 2 had class 3A; 11 had class 3B, and 2 had class 4. Of 20 patients 11 (55%) survived. However, those patients who died had severe EPN based on radiological class (6 had class 3B and 1 had class 4). There was no significant difference between the survivor and non-survivor groups with respect to age, gender, duration of diabetes mellitus, duration of symptoms, serum creatinine level, total leukocyte count, hemoglobin, platelet count and culture positivity.


CONCLUSIONS
Computerized tomographic class 3B or 4 is the most reliable predictor of outcome in patients with ERTD.
Dutta
Pinaki
P
Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Bhansali
Anil
A
Singh
S K
SK
Gupta
K L
KL
Bhat
M H
MH
Masoodi
S R
SR
Kumar
Yashwant
Y
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods*; D003920:Diabetes Mellitus; D004646:Emphysema / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014570:Urologic Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy
D000900:Anti-Bacterial Agents