title: [Results of conservative management of emphysematous pyelonephritis].
abstract: BACKGROUND
  Emphysematous pyelonephritis (EPN) is a rare and severe, necrotizing infection of the kidney. Diagnosis should be precocious based on computed tomography (CT). Its management remains controversial and its treatment is currently increasingly conservative. The aim of this paper is to discuss the conservative treatment of this disease through our experience in 21 patients.
  
  
  METHODS
  A retrospective analysis including 21 patients managed conservatively for an emphysematous pyelonephritis in our department from January 2010 to April 2015. Follow-up ranged from three to 24 months.
  
  
  RESULTS
  Of the 24 patients, seven belonged to class 1, twelve to class 2 and two to class 4. Obstruction of the upper urinary tract was found in 16 cases. On the risk factor stratification, thrombocytopenia was found in five cases, renal function impairment in 10 cases and a septic shock in four cases. All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad-spectrum antibiotics. Drainage of the urinary tract was performed by double-J stent in 14 patients and with ureteral catheter in six patients. One patient had urinary distension secondary to a urethral stricture with bilateral emphysematous pyelitis. In this case, drainage consisted in suprapubic bladder catheter only. The outcome was favorable in 18 patients and the control CT showed a decline or complete disappearance of gas in urinary tract and/or renal parenchyma after an average period of 12 days. A secondary nephrectomy was performed in two cases. Specific mortality rate was zero.
  
  
  CONCLUSIONS
  PNE remains a severe infection involving the vital prognosis. Computed tomography makes an early diagnosis. Treatment should be conservative based on the association of medical intensive care and drainage, percutaneous or endoscopic, urgently. Nephrectomy should be reserved for extensive forms with multiple organ dysfunction or failure of conservative treatment.
authors: Service d'urologie, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 Tunis, Tunisie. Electronic address: saadiahmedrabta@gmail.com.
authors: Ahmed
authors: A
authors: Saadi
authors: Service d'urologie, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 Tunis, Tunisie.
authors: Haroun
authors: H
authors: Ayed
authors: Service d'urologie, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 Tunis, Tunisie.
authors: Abderrazak
authors: A
authors: Bouzouita
authors: Service d'urologie, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 Tunis, Tunisie.
authors: Mohamed
authors: M
authors: Cherif
authors: Service d'urologie, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 Tunis, Tunisie.
authors: Walid
authors: W
authors: Kerkeni
authors: Service d'urologie, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 Tunis, Tunisie.
authors: Selim
authors: S
authors: Selmi
authors: Service d'urologie, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 Tunis, Tunisie.
authors: Riadh
authors: R
authors: Ben Slama
authors: Service d'urologie, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 Tunis, Tunisie.
authors: Amine
authors: A
authors: Derouiche
authors: Service d'urologie, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 Tunis, Tunisie.
authors: Mohamed
authors: M
authors: Chebil
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000072700:Conservative Treatment / Q000379:methods; D004646:Emphysema / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011704:Pyelonephritis / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013396:Suction / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Chirurgie; Conservative management; Drainage; Emphysematous pyelonephritis; Pyélonéphrite emphysémateuse; Surgery; Traitement conservateur