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[Emphysematous pyelonephritis. Apropos of 4 cases]
Summary
Emphysematous pyelonephritis, a severe kidney infection often seen in diabetics, requires prompt diagnosis. Nephrectomy is the primary treatment, but mortality remains high due to complications like septic shock.
Area of Science:
- Nephrology
- Infectious Diseases
- Radiology
Background:
- Emphysematous pyelonephritis (EPN) is a rare, severe necrotizing infection of the kidney.
- Diabetes mellitus is a significant risk factor for EPN.
- Patients often present with non-specific symptoms, delaying diagnosis.
Observation:
- Four cases of EPN are presented (3 female, 1 male), all with diabetes.
- Conventional X-rays suggested diagnosis, confirmed by computed tomography (CT).
- CT imaging demonstrated gas diffusion within or beyond the renal compartment.
Findings:
- Common causative organisms included E. coli, Klebsiella pneumoniae, and Candida albicans.
- Nephrectomy was the definitive treatment, performed either primarily or after initial drainage.
- Two patients died from septic shock and end-stage renal failure, highlighting the severe prognosis.
Implications:
- Early diagnosis of EPN using imaging is crucial.
- Aggressive management, often involving nephrectomy, is necessary.
- EPN carries a high mortality rate, particularly in diabetic patients with complications.