Gaspar-Alberto Motta-Ramírez, Lluvia-Irais González-Merino, José-Arturo Castillo-Lima, Flores-Terrazas E, Francisco-Manuel Bustamante-Romero, Ríos-Mondragón L

Language: Spanish
References: 13
Page: 5-12
PDF size: 280.48 Kb.

ABSTRACT

Introduction: Emphysematous pyelonephritis (EPN) is a rare, severe, acute bacterial infection of the kidney. Purpose: To elucidate the clinical features, radiological classification and diagnosis of EPN based on radiological confirmation of gas within the kidney or collecting system. Materials and methods: The imaging studies and clinical outcomes of patients with EPN from December, 1976 to February, 2013 were retrospectively studied. The imaging studies performed included radiography, ultrasonography (US) and computed tomography (CT) using Huang classification in four classes and Wang classification in two classes. Results: We made an analysis of all the patients with diagnosis of EPN in 36 years 2 months; we included 43 patients: 32 women (74%) and 11 men (26%), using Huang classification in four classes: Class 1: 14 patients (33%); class 2: 2 patients (5%); class 3: A, 6 patients (14%) and B, 8 patients (19%), and class 4: 4 patients (9%). We identified 6 patients (14%) with renal focal necrotic lesion like an abscess and 4 patients (9%) with emphysematous cystitis. Conclusions: CT is an efficient imaging method for diagnosis, guiding the drainage procedures and monitoring response to antibiotic treatment. Diagnosis of EPN was made based on the imaging studies and CT findings.

REFERENCES

1. Motta-Ramírez GA, Noriega-García JL, Castillo-Lima JA. Pielonefritis enfisematosa: revisión retrospectiva y análisis de la literatura. Rev Mex Radiol. 2000; 54: 19-23.

2. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Inter Med. 2000; 160 (6): 797-805.

3. Ricardez-Espinoza A, Tavera-Ramírez G, López-Silvestre JC et al. Pielonefritis enfisematosa versus pielitis enfisematosa: abordaje actual. Rev Mex Urol. 2003; 63 (3): 95-105.

4. Flores-Alfaro E, Parra-Rojas I, Jiménez-Acevedo A, Fernández-Tilapa G. Pruebas presuntivas del análisis de orina en el diagnóstico de infección en vías urinarias entre diabéticos tipo 2. Salud Publica Mex. 2005; 47: 376-380.

5. Goswami R, Bal CS, Tejaswi S, Punjabi GV, Kapil A, Kochupillai N. Prevalence of urinary tract infection and renal scars in patients with diabetes mellitus. Diabetes Res Clin Pract. 2001; 53 (3): 181-186.

6. Wang YL, Lee TY, Bullard MJ et al. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology. 1996; 198: 433-438.

7. Schultz EH Jr, Klorfein EH. Emphysematous pyelonephritis. J Urol. 1962; 87: 762-766.

8. Grayson DE, Abbott RM, Levy AD, Sherman PM. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics. 2002; 22: 543-561.

9. Blanco-Díez A, Barbagelata-López A, Fernández-Rosado E, Casas-Muíño R, Chantada-Abal V, González-Martín M. Pielonefritis enfisematosa: presentación de un caso y revisión de la literatura. Actas Urol Esp. 2003; 27 (9): 721-725.

10. Aswathaman K, Gopalakrishnan G, Gnanaraj L, Chacko NK, Kekre NS, Devasia A. Emphysematous pyelonephritis: outcome of conservative management. Urology. 2008; 71: 1007-1009.

11. Chen MT, Huang CN, Chou YH et al. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience. J Urol. 1997; 157: 1569-1573.

12. Woodward S, Elsayes KM, Akhtar AL. Imaging of emphysematous pyelonephritis: self-assessment module. AJR. 2010; 194: S70-S72.

13. Pontin AR, Barnes RD. Current management of emphysematous pyelonephritis. Nat Rev Urol. 2009; 6: 272-279.