A Bubbly Nephron – Emphysematous Pyelonephritis, A Case Report and Literature Review - Abstract
Emphysematous pyelonephritis (EPN) is a rare gas producing necrotizing infection of renal parenchyma, which overlooked can lead to a mortality rate as high as 80%. A 54-year-old female with a history of diabetes presented to the emergency department with dull left sided flank pain. She computed tomographic (CT) scan showed air in the renal collecting system in addition to an obstructing stone, confirming the diagnosis of EPN. She was admitted, received intravenous (IV) antibiotics, and underwent a procedure to place aureteralstent to help relieve the obstructing stone. She improved clinically and was able to be discharged home. EPN is most common in the diabetic and female populations. Most notably, Escherichia coli, Klebsiella and Proteus speciesare the most common bacteria found in blood and urinary cultures in these cases. Management depends on radiological staging of EPN by CT scan. Class 1 can be managed with antibiotics alone; classes 2 and 3 need percutaneous drainage in addition to antibiotics. High risk class 3 is indicated by the presence of thrombocytopenia, renal failure, altered mental status or shock on presentation in which case a nephrectomy could be required. Regardless of class, all patients with EPN and an obstructing stone should surgical intervention. Additionally, if the initial intervention fails, nephrectomy should be pursued given the high mortality of this disease. Diagnosis of EPN requires a high degree of suspicion. After diagnosis, patients should be monitored closely and managed with IV antibiotics as well as an individualized surgical approach, depending on radiological staging and risk factors.