title: Emphysematous infections of the kidney and urinary tract: a single-center experience.
abstract: Emphysematous pyelonephritis (EPN) is a group of potentially life-threatening conditions seen particularly in diabetics, leading to high morbidity and mortality. Our aim was to study the profile of emphysematous infections of the kidney and urinary tract and evaluate the effect of early surgical intervention on mortality. This is an observational study conducted in a tertiary care hospital between January 2009 and January 2013, in which the clinical, laboratory, microbiological and radiological profiles of patients with EPN (diagnosed based on clinical, laboratory and imaging findings) was studied. A total of 12 patients were studied, including 10 with diabetes. A total of 66.6% had pyelonephritis, 25% had both cystitis and pyelonephritis and 8.3% had only cystitis; involvement of the left kidney was more common and bilateral involvement was seen in two cases. The clinical features seen in the patients included fever (100%), features of urinary infection (66.6%) and flank pain (50%). Culture positivity was seen in only 50% of the cases. Ten patients underwent percutaneous drainage (PCD) within 24 h, and two of these patients required nephrectomy subsequently. All patients were followed-up for one month. There was one death (mortality 8.3%), and all other patients responded well and recovered. Our study suggests that EPN is a potentially life-threatening condition that requires aggressive and prompt medical therapy with early PCD to reduce morbidity and mortality. Nephrectomy should be reserved for cases that do not respond to PCD.
authors: Department of Internal Medicine, Armed Forces Medical College, Pune, India.
authors: Vineet
authors: V
authors: Behera
authors: R S
authors: RS
authors: Vasantha Kumar
authors: Satish
authors: S
authors: Mendonca
authors: Peeyush
authors: P
authors: Prabhat
authors: Nardeep
authors: N
authors: Naithani
authors: Velu
authors: V
authors: Nair
mesh_terms: D000328:Adult; D000368:Aged; D003556:Cystitis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D004322:Drainage; D004646:Emphysema / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011704:Pyelonephritis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome