Emphysematous pyelonephritis: Our experience in managing these cases.
BACKGROUND
Emphysematous pyelonephritis (EPN) is a rare acute necrotising infection of renal parenchyma. We discuss clinical details and treatment strategies of 8 patients with EPN followed at our clinic.


METHODS
We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 8 patients with EPN followed at our urology clinic between 2012 and 2015.


RESULTS
The mean patient age (female: 5; male: 3) was 62 (range: 51-82) years. Based on computed tomographic findings, EPN was classified as class 1 (n = 3), class 2 (n = 3) and class 3a (n = 2). All patients had fever, flank pain, nausea, and vomiting. Five patients had type 2 diabetes mellitus and 3 diabetic patients also had renal stones. Escherichia coli (n = 6), Klebsiella species (n = 1), and Proteus species (n = 1) were grown in urine cultures. All patients had unilateral involvement. Increased white blood cell counts, sedimentation rate, and C-reactive protein levels were detected in all cases. In addition to medical treatment, 2 patients underwent a nephrostomy catheter placement and another 2 patients underwent nephrectomy upon deterioration of her general health state. After achieving clinical stabilization with medical treatment, 1 patient underwent endoscopic ureteral stone treatment. The remaining 3 cases were treated only with antibiotherapy. All patients were discharged with clinical cure.


CONCLUSIONS
Mortality rates of EPN are gradually decreasing. Preservation of renal reserve is possible due to early diagnosis, appropriate antibiotherapy, and drainage.
Fatih Sultan Mehmet Research and Training Hospital, Istanbul.
Fatih
F
Uruc
Fatih Sultan Mehmet Research and Training Hospital, Istanbul.
Ozgur Haki
OH
Yuksel
Fatih Sultan Mehmet Research and Training Hospital, Istanbul.
Aytac
A
Sahin
Fatih Sultan Mehmet Research and Training Hospital, Istanbul.
Ahmet
A
Urkmez
Fatih Sultan Mehmet Research and Training Hospital, Istanbul.
Caglar
C
Yildirim
Fatih Sultan Mehmet Research and Training Hospital, Istanbul.
Ayhan
A
Verit