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Necrotizing emphysematous pyelonephritis: a case report.

A Pinna, E Usai, F M Cossu

    International Journal of Clinical Pharmacology, Therapy, and Toxicology
    |June 1, 1985
    PubMed
    Summary
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    Emphysematous pyelonephritis (EP) is a rare kidney infection. This case highlights a diabetic man with EP, E. coli infection, and a rare vena cava fistula, emphasizing the need for surgical exploration.

    Area of Science:

    • Urology
    • Nephrology
    • Infectious Diseases

    Background:

    • Emphysematous pyelonephritis (EP) is a severe necrotizing renal parenchymal infection.
    • It is uncommon, with only 45 cases reported historically.
    • EP is typically associated with urinary tract obstruction.

    Observation:

    • A 43-year-old diabetic male presented with right-sided EP.
    • The patient had an E. coli urinary tract infection but no urinary tract obstruction.
    • Surgical exploration revealed a fistula between the kidney and the vena cava.

    Findings:

    • The identified fistula posed a risk of fatal complications.
    • Commonly implicated microorganisms include E. coli, Proteus, Aerobacter, and anaerobes.
    • Mortality rates are significantly higher with medical therapy alone (75%) compared to surgical intervention (23%).

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    Implications:

    • Surgical exploration is crucial for detecting occult pathologies, even in the absence of urinary tract obstruction.
    • Early surgical intervention improves outcomes and reduces mortality in EP.
    • This approach aids in assessing the potential reversibility of renal lesions.