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Emphysematous pyelonephritis
From WikEM
Contents
Background
- Rare gas-forming infection nearly always occurring in patients with DM and obstruction
- Patients appear toxic and septic; nephrectomy may be required
Clinical Features[1]
- Fever
- Abdominal pain or Flank pain
- crepitus over the flank may be present in severe cases
- Nausea/vomiting
- Dyspnea
- Renal dysfunction
- Altered mental status
- Shock
- Thrombocytopenia
Differential Diagnosis
Dysuria
- Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
- Nephrolithiasis
- Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
- Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Uterine/bladder/vaginal prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Behavioral symptom without detectable pathology
Evaluation
Labs
- CBC with high WBC, low platelets
- Urinalysis with urine culture
- Creatinine
- Blood culture
Imaging
- CT is definitive
- Staging[2]:
- Class 1 - gas confined to collecting system
- Class 2 - gas confined to renal parenchyma alone
- Class 3A - perinephric extension of gas or abscess
- Class 3B - extension of gas beyond Gerota fascia
- Class 4 - b/l or EPN in solitary kidney
Management
- IVF
- Antibiotics
- IV ampicillin, gentamicin, metronidazole
- Vancomycin in place of ampicillin for penicillin allergy
Disposition[3]
- Poor prognostic risk factors:
- Creatinine > 1.4mg/dL
- Platelets < 60k
- Altered mental status
- Shock
- Urological consult for percutaneous drainage, stent placement, or nephrectomy (classes 3 and 4 with 2 or more prognostic risk factors)
- Presence of obstructive stone requires even more urgent surgical intervention
- Mortality rates between ~20-40%
See Also
External Links
References
- ↑ Tang HJ, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001 Jun. 34(2):125-30.
- ↑ Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000 Mar 27. 160(6):797-805.
- ↑ Shetty S et al. Emphysematous Pyelonephritis Treatment & Management. eMedicine. Apr 11, 2014. http://emedicine.medscape.com/article/457306-treatment#showall.
Authors
Kevin Lu, Catie Reynolds, Ross Donaldson, Neil Young, Daniel Ostermayer
