Emphydematous pyelonephritis - Treat the patient, not the scan

Abstract

Background: Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma. Until the late 1960s, these patients were treated with nephrectomies as EPN is associated with a high rate of mortality. It is a diagnosis based on computed tomography (CT) scan of the patient and based on the results, can be classified according to the severity of the disease. In our case report, we present a patient with seemingly extensive EPN on CT scan who was treated successfully with intravenous antibiotics (IV) and percutaneous drainage.
Methods: Together with current literature, our case study adds to increasing evidence which supports how carefully selected patients can be treated with the above modalities.
Results: We present a 75 year old diabetic Indian gentleman who came to us with right iliac fossa pain and was noted to have a positive right renal punch. CT scan revealed extensive gas in the right kidney. Considering that he was clinically stable amongst other factors, he was started on appropriate IV antibiotics and underwent a percutaneous nephrostomy tube insertion. Subsequent follow-up scans showed resolution of the EPN.
Conclusions: EPN is a severe, necrotizing infection of the kidneys associated with high mortality rates. As such, physicians need to have a high index of suspicion in patients who are at risk. There is increasing evidence to show that patients with early EPN can and should be treated with appropriate IV antibiotics and percutaneous drainage procedures. We hope that this will help to increase awareness of the possible treatment modalities of this potentially life-threatening disease.