eMedicine Specialties > Radiology > Genitourinary

Emphysematous Pyelonephritis: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Colm Boylan, MRCP, FRCR, Specialist Registrar, Department of Radiology, North Manchester General Hospital NHS Trust, UK; Brendan Costello, MD, Clinical Director, Department of Urology, North Manchester General Hospital; Khalid Mahmood, MBBS, FCPS, Locum Appointment Training Specialist Registrar, Department of Radiology - Paediatric, Royal Liverpool (Alder Hey) Children's Hospital
Contributor Information and Disclosures

Updated: Jan 25, 2008

Intervention

Treatment involves aggressive antibiotic therapy, drainage procedures to relieve obstruction, and prompt nephrectomy in life-threatening situations.13,20,21,22

With early diagnosis and the aggressive and prompt administration of antibiotics, therapeutic success may be achieved in select patients.20 Percutaneous nephrostomy and percutaneous perinephric drainage may preclude nephrectomy in some patients. Occasionally, drainage procedures alone are successful; however, most patients require immediate surgical intervention.

Combined treatment of EPN with broad-spectrum antibiotics and percutaneous renal drainage was found to be safe and effective in the treatment of 10 patients with EPN. This treatment may be used an alternative to nephrectomy in high-risk patients not suitable for general anesthesia.20

Medicolegal Pitfalls

  • EPN is a rare but life-threatening suppurative infection of the renal parenchyma and perirenal tissues.
  • For successful treatment of patients with EPN, appropriate medical therapy should be initiated, and immediate nephrectomy or drainage should not be delayed.
  • Although percutaneous drainage combined with antibiotics is an acceptable alternative, surgery should not be delayed. As to the stage at which surgery should be performed, the decision should be based on a combination of imaging and clinical findings.
  • Serum creatinine levels are the most reliable predictors of the outcome.

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Acknowledgments

The authors and editors would like to acknowledge the contributions made to this article by Ramesh Chandra Raja, MBBCH, and Philip Wiles, MD.



More on Emphysematous Pyelonephritis

Overview: Emphysematous Pyelonephritis
Imaging: Emphysematous Pyelonephritis
Follow-up: Emphysematous Pyelonephritis
Multimedia: Emphysematous Pyelonephritis
References
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References

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Further Reading

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Keywords

EPN, upper urinary tract infection, renal tract infections with intraparenchymal renal gas, emphysematous pyelitis, perinephric emphysema, urinary tract infection, gas in the kidney, renal gas, Escherichia coli, E coli, Klebsiella pneumoniae, K pneumoniae, Proteus mirabilis, P mirabilis

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Colm Boylan, MRCP, FRCR, Specialist Registrar, Department of Radiology, North Manchester General Hospital NHS Trust, UK
Colm Boylan, MRCP, FRCR is a member of the following medical societies: Royal College of Radiologists
Disclosure: Nothing to disclose.

Brendan Costello, MD, Clinical Director, Department of Urology, North Manchester General Hospital
Brendan Costello, MD is a member of the following medical societies: British Medical Association
Disclosure: Nothing to disclose.

Khalid Mahmood, MBBS, FCPS, Locum Appointment Training Specialist Registrar, Department of Radiology - Paediatric, Royal Liverpool (Alder Hey) Children's Hospital
Disclosure: Nothing to disclose.

Medical Editor

Steven Perlmutter, MD, FACR, Clinical Associate Professor, Radiology Residency Program Director, Radiology Medical Director, Department of Radiology, University Hospital at Stony Brook
Steven Perlmutter, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Medical Association, American Roentgen Ray Society, Association of Program Directors in Radiology, Association of University Radiologists, Medical Society of the State of New York, Radiological Society of North America, Society of Breast Imaging, Society of Nuclear Medicine, and Society of Uroradiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Arnold C Friedman, MD, FACR, Associate Chairman, Department of Radiology, University of Florida Health Science Center; Chief, Department of Radiology, Shands-Jacksonville Hospital
Arnold C Friedman, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Staff, Department of Radiology, Virginia Mason Medical Center
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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