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[Two patients with emphysematous pyelonephritis].

R van der Kamp1, J E Nienhuis, P A Rosekrans

  • 1Ikazia Ziekenhuis, Rotterdam.

Nederlands Tijdschrift Voor Geneeskunde
|April 25, 2000
PubMed
Summary
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Emphysematous pyelonephritis is a severe kidney infection, often seen in diabetic patients or those with urinary obstruction. Prompt drainage and potential nephrectomy are crucial for treatment.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Oncology

Background:

  • Emphysematous pyelonephritis (EPN) is a rare, necrotizing infection of the kidney.
  • It predominantly affects patients with diabetes mellitus or urinary tract obstruction.
  • Early diagnosis and intervention are critical due to the severity of the condition.

Observation:

  • Two cases are presented: a 55-year-old male with diabetes and a 40-year-old female with asthmatic bronchitis.
  • Both patients presented with abdominal pain, renal dysfunction, and gas within the renal pelvis on CT scan.
  • The male patient had Escherichia coli bacteremia and a difficult recovery despite antibiotics and percutaneous drainage.

Findings:

  • The male patient's CT revealed hydronephrosis with a perirenal inflammatory infiltrate.

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  • The female patient had a calculus obstructing the pyelo-ureteral passage, and her resected kidney revealed squamous cell carcinoma.
  • The female patient recovered after surgery and chemotherapy.

    • Implications:

    • This case series highlights the diverse presentations and underlying causes of EPN, including malignancy.
    • Percutaneous drainage and nephrectomy remain key interventions for managing EPN.
    • Optimal management requires addressing both the infection and any contributing factors like obstruction or malignancy.