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Emphysematous Pyelonephritis (EPN) Clinical Presentation

  • Author: Sugandh Shetty, MD, FRCS; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Dec 30, 2015
 

History and Physical Examination

Patients typically present with fever (79%), abdominal or flank pain (71%), nausea and vomiting (17%), dyspnea (13%), acute renal impairment (35%), altered sensorium (19%), shock (29%), and thrombocytopenia (46%).

Crepitus over the flank area may occur in advanced cases of EPN. Pneumaturia is uncommon unless emphysematous cystitis is present. Subcutaneous emphysema and pneumomediastinum have also been reported in a case of EPN.[12] Comorbidities include alcoholism, malnourishment, renal calculi, and diabetic ketoacidosis.

 
 
Contributor Information and Disclosures
Author

Sugandh Shetty, MD, FRCS Associate Professor of Urology, Oakland University William Beaumont School of Medicine; Attending Physician, Department of Urology, William Beaumont Hospital

Sugandh Shetty, MD, FRCS is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ajay K Singh, MB, MRCP, MBA Associate Professor of Medicine, Harvard Medical School; Director of Dialysis, Renal Division, Brigham and Women's Hospital; Director, Brigham/Falkner Dialysis Unit, Faulkner Hospital

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

References
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  2. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000 Mar 27. 160(6):797-805. [Medline].

  3. Tang HJ, Li CM, Yen MY, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001 Jun. 34(2):125-30. [Medline].

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  12. Wang YC, Wang JM, Chow YC, Chiu AW, Yang S. Pneumomediastinum and subcutaneous emphysema as the manifestation of emphysematous pyelonephritis. Int J Urol. 2004 Oct. 11(10):909-11. [Medline].

  13. Tsu JH, Chan CK, Chu RW, Law IC, Kong CK, Liu PL, et al. Emphysematous pyelonephritis: an 8-year retrospective review across four acute hospitals. Asian J Surg. 2013 Jul. 36(3):121-5. [Medline].

  14. Fatima R, Jha R, Muthukrishnan J, Gude D, Nath V, Shekhar S, et al. Emphysematous pyelonephritis: A single center study. Indian J Nephrol. 2013 Mar. 23(2):119-24. [Medline]. [Full Text].

  15. Langston CS, Pfister RC. Renal emphysema. A case report and review of the literature. Am J Roentgenol Radium Ther Nucl Med. 1970 Dec. 110(4):778-86. [Medline].

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  17. Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology. 1996 Feb. 198(2):433-8. [Medline].

  18. Uruc F, Yuksel OH, Sahin A, Urkmez A, Yildirim C, Verit A. Emphysematous pyelonephritis: Our experience in managing these cases. Can Urol Assoc J. 2015 Jul-Aug. 9 (7-8):E480-3. [Medline].

  19. Aboumarzouk OM, Hughes O, Narahari K, Coulthard R, Kynaston H, Chlosta P, et al. Emphysematous pyelonephritis: Time for a management plan with an evidence-based approach. Arab J Urol. 2014 Jun. 12 (2):106-15. [Medline].

  20. Nana GR, Brodie A, Akhter W, Karim O, Motiwala H. Nephroureterectomy for emphysematous pyelonephritis: An aggressive approach is sometimes necessary. A case report and literature review. Int J Surg Case Rep. 2015. 10:179-82. [Medline].

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  23. Gaither K, Ardite A, Mason TC. Pregnancy complicated by emphysematous pyonephrosis. J Natl Med Assoc. 2005 Oct. 97(10):1411-3. [Medline]. [Full Text].

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Kidneys, ureter, and bladder imaging showing a streaky gas pattern over the entire right kidney in a patient with emphysematous pyelonephritis.
Emphysematous pyelonephritis. Kidneys, ureter, and bladder imaging showing gas over the region of the right kidney. White arrows outline the area. The faint outline of a staghorn calculus can be seen in the right kidney.
Emphysematous pyelonephritis. Renal sonogram showing hyperechoic shadows suggestive of gas along the lower pole of the kidney.
Emphysematous pyelonephritis. CT scan showing gas in the left kidney, with stones and xanthogranulomatous pyelonephritis.
CT scan showing right renal and perinephric gas in a patient with emphysematous pyelonephritis.
CT scan showing gas in both kidneys and the inferior vena cava in a patient with bilateral emphysematous pyelonephritis.
Algorithm for the management of emphysematous pyelonephritis.
 
 
 
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