Gállego-Sales S, Jamaica-Verduzco E, González-Rangel G, López-Retamosa AK

Language: Spanish
References: 10
Page: 315-318
PDF size: 1099.68 Kb.

ABSTRACT

Bilateral emphysematous pyelonephritis is a rare, serious disease with a high mortality rate. It presents with greater frequency in diabetic patients with obstructive uropathy although there are other risk factors such as immunosuppression, alcoholism, cirrhosis, and kidney failure. Radiologically it is classified as: type 1, when only the collecting system is affected; type 2, when there is gas inside the renal parenchyma; type 3, which is subdivided into a) when it involves the perirenal space and b) when it involves the pararenal space; and type 4, when it affects both kidneys or a solitary kidney (10% of cases). The mortality rate is approximately 25% and medical treatment alone, bilateral involvement, thrombocytopenia, serum creatinine and urea elevation, and hypotension secondary to septic shock have been recognized as prognostic factors. The case presented here is a 52-year-old diabetic woman with serious symptoms of bilateral involvement who was successfully treated with minimally invasive procedures and medical management

REFERENCES

1. Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk factors for mortality in patients with emphysematous pyelonephritis: a metaanalysis. J Urol 2007;178(3 Pt 1):880-5

2. Karasavidou L, Nikolaou S, Archontakis S. Nonsurgical treatment of bilateral emphysematous pyelonephritis in a diabetic patient. J Nephrol 2006;19:664-7.

3. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis and pathogenesis. Arch Intern Med 2000;160:797-805.

4. Melero M, Sarquis S, Biancolini C. Acute bilateral emphisematous pyelonephritis. A therapeutic challenger. Medicina (B Aires) 2007;67:282-4.

5. Sodqi M, Marih L, Nassib M, Himmich H. Bilateral emphysematous pyelonephritis cured by medical therapy alone. Med Mal Infect 2006;36:174-6.

6. Flores G, Nellen H, Magaña F, Calleja J. Acute bilateral emphysematous pyelonephritis successfully managed by medical therapy alone: a case report and review of the literature. BMC Nephrol 2002;3:4.

7. Lim CS, Kim WB, Kim YS. Bilateral emphysematous pyelonephritis with perirenal abscess cured by conservative therapy. J Nephrol 2000;13:155-8.

8. Derouiche A, Ouni A, Agrevi A, et al. Management of emphysematous pyelonephritis based on a series of 21 cases Prog Urol 2008;18:102-7.

9. Hart PD, Vaseemuddin M, Egiebor O. Bilateral emphysematous pyelonephitis in a patient with no known risk factors. J Natl Med Assoc 2007;99:179-81.

10. Arun N, Hussain A, Kapoor M, Abul F. Bilateral emphysematous pyelonephritis and emphysematous cystitis with autosomal dominant polycystic kidney disease: is conservative management justified? Med Princ Pract 2007;16:155-7.