title: Emphysematous pyelitis: epidemiological, therapeutic and evolutive features.
abstract: OBJECTIVE
  Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis.
  
  
  METHODS
  The data of six patients managed for emphysematous pyelitis were collected and analyzed.
  
  
  RESULTS
  The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned -- dedifferentiated -- renal parenchyma. Outcome was good.
  
  
  CONCLUSIONS
  Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy.
authors.affiliation: Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Amine
authors.initials: A
authors.lastname: Derouiche
authors.forename: Rabii
authors.initials: R
authors.lastname: El Attat
authors.forename: Hassen
authors.initials: H
authors.lastname: Hentati
authors.forename: Mehdi
authors.initials: M
authors.lastname: Blah
authors.forename: Anis
authors.initials: A
authors.lastname: Slama
authors.forename: Mohamed
authors.initials: M
authors.lastname: Chebil
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D004646:Emphysema / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011702:Pyelitis / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents