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Emphysematous pyelonephritis with calculus: Management strategies
Tanmaya Goel1, Sreedhar Reddy, Joseph Thomas
1Department of Urology, Kasturba Medical College, Manipal, India.
Summary
Emphysematous pyelonephritis (EPN) with calculus can be successfully treated without nephrectomy. Initial conservative management of EPN followed by stone removal preserves renal function.
Area of Science:
- Urology
- Nephrology
- Infectious Diseases
Background:
- Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the kidney.
- EPN co-occurring with urinary calculi presents unique management challenges.
- Limited data exists on the optimal treatment strategies for EPN with stones.
Purpose of the Study:
- To report on the experience of managing emphysematous pyelonephritis with concurrent urinary calculi.
- To evaluate the efficacy of a stepwise treatment approach.
- To highlight the potential for renal function preservation.
Main Methods:
- A retrospective analysis of seven cases (eight renal units) of EPN over four years.
- Two patients (three renal units) with EPN and urinary calculi were identified.
- Initial conservative management of EPN followed by staged stone removal was employed.
Main Results:
- EPN was effectively managed with antibiotics and supportive care.
- Subsequent stone clearance was achieved through stepwise open or endoscopic procedures.
- Postoperative complications were managed, and renal function was preserved.
Conclusions:
- Nephrectomy is not the only treatment option for EPN with stones.
- A combined conservative and surgical approach can lead to successful outcomes.
- This strategy effectively manages infection and preserves kidney function.
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