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Intrarenal Injection of Escherichia coli in a Rat Model of Pyelonephritis
Published on: July 18, 2017
Current management of emphysematous pyelonephritis
Alan R Pontin1, Richard D Barnes
1Division of Urology, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa. lesley.burke@uct.ac.za
Nature Reviews. Urology
|May 9, 2009
Summary
Emphysematous pyelonephritis (EPN) is a severe kidney infection causing gas production, primarily in diabetic women. Early diagnosis and treatment, especially in diabetics with urinary infections, can help avoid nephrectomy.
Area of Science:
- Nephrology
- Infectious Diseases
- Radiology
Background:
- Emphysematous pyelonephritis (EPN) is a necrotizing renal infection characterized by gas production within the kidney parenchyma.
- It predominantly affects female patients with diabetes mellitus, often without ureteric obstruction.
- Nondiabetic patients may develop EPN, but typically present with ureteric obstruction and less extensive disease.
Purpose of the Study:
- To summarize the characteristics, diagnosis, and management of emphysematous pyelonephritis.
- To highlight the role of diabetes as a primary risk factor and the impact of early diagnosis.
- To discuss the evolution of diagnostic tools like CT for staging EPN.
Main Methods:
- Review of existing literature on EPN.
- Analysis of clinical presentation, risk factors, and treatment outcomes.
- Discussion of diagnostic imaging, particularly CT, and its role in staging.
Main Results:
- EPN is a severe infection often presenting with vague symptoms followed by rapid deterioration.
- Carbon dioxide gas is a key component, generated by bacterial fermentation of glucose in diabetic patients.
- CT imaging has enabled a staging system for gas patterns, aiding in risk stratification and management.
Conclusions:
- Prompt resuscitation, antibiotic therapy, and management of metabolic derangements are crucial for EPN treatment.
- Percutaneous drainage is the preferred management, with nephrectomy reserved for extensive renal destruction.
- Early diagnosis and treatment of urinary infections in diabetics may prevent the need for nephrectomy.
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