title: Successful medical treatment of emphysematous pyelonephritis in chronic hemodialysis.
abstract: Emphysematous pyelonephritis (EPN) is a life-threatening renal infection caused by gas-producing bacteria and fungi. It usually occurs in patients with diabetes and patients with urinary tract obstruction. A combination of systemic antibiotics, percutaneous catheter drainage, or open nephrectomy is typically required to achieve cure. Because of grim prognosis, resorting to interventional methods is frequently inevitable. We report the case of a 77-year-old woman with diabetes and end-stage renal disease on chronic hemodialysis that presented with fever and left flank pain. A bubbly gas pattern inside the left kidney was demonstrated on abdominal computed tomography scan and blood cultures grew Escherichia coli. She was successfully treated solely with systemic antibiotics. This highlights the fact that prompt recognition of imaging findings associated with benign prognosis is essential for a favorable outcome. It allows for an effective management avoiding high-risk interventions, especially in frail patients with multiple comorbidities. Finally, we review all published cases of EPN in chronic dialysis patients.
authors: Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece.
authors: Georgios
authors: G
authors: Vlachopanos
authors: Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece.
authors: Theodoros
authors: T
authors: Kassimatis
authors: Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece.
authors: Adamantia
authors: A
authors: Zerva
authors: Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece.
authors: Anastasia
authors: A
authors: Kokkona
authors: Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece.
authors: Eirini
authors: E
authors: Stavroulaki
authors: Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece.
authors: Charilaos
authors: C
authors: Zacharogiannis
authors: Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece.
authors: Athanasios
authors: A
authors: Agrafiotis
mesh_terms: D000368:Aged; D004646:Emphysema / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D011704:Pyelonephritis / Q000188:drug therapy*; D006435:Renal Dialysis / Q000009:adverse effects*
keywords: Emphysematous pyelonephritis; end-stage renal disease; hemodialysis; peritoneal dialysis