Emphysematous pyelonephritis: a 15-year experience with 20 cases

To review our experience with emphysematous pyelonephritis over the past 15 years.

Twenty patients with emphysematous pyelonephritis were reviewed regarding diagnosis, treatment, and outcome.

Women outnumbered men (75% versus 25%), and 80% of patients were diabetic. The left kidney was more frequently affected than the right one (60% versus 35%) and both kidneys were involved in 5%. Obstruction of the corresponding renoureteral unit was found in all the nondiabetic and in half of the diabetic patients. Diagnosis was confirmed by gas in the parenchyma or perinephric space by plain x-ray of the abdomen or computed tomography. Escherichia coli was the most common organism; it was found in 70% of urine cultures. A prompt attempt to control diabetes was made, and intravenous antibiotics were given. Nephrectomy was immediately performed after stabilization of the general condition of the patients. A total of 80% of patients survived the procedures.

For successful management of emphysematous pyelonephritis, appropriate medical treatment should be attempted but immediate nephrectomy should not be delayed.