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emphysematous pyelonephritis
Etiology:
- diabetes mellitus is the most important risk factor
- pathogens
- E coli (most common)
- Proteus
- Klebsiella
- anaerobic Streptococci
- Candida
Pathology:
- renal emphysema (gas & pus in the renal parenchyma)
Management:
- antibiotic treatment to cover gram-negative organisms
- cephalosporin or fluoroquinolone
- piperacillin tazobactam (Zosyn) or carbapenem if high risk of resistant organism
- percutaneous drainage of gas & pus
- relieves urinary obstruction
- nephrectomy may be needed if percutaneous drainage unsuccessful
General
pyelonephritis
References
- NEJM Knowledge+ Nephrology/Urology
- Bjurlin MA, Hurley SD, Kim DY et al
Clinical outcomes of nonoperative management in emphysematous urinary tract
infections.
Urology. 2012 Jun;79(6):1281-5.
PMID: 22513034
- Pontin AR, Barnes RD.
Current management of emphysematous pyelonephritis.
Nat Rev Urol. 2009 May;6(5):272-9.
PMID: 19424175 Review