Ma LP, Zhou N, Fu Y, Liu Y, Wang C, Zhao B. Emphysematous pyelonephritis: Six case reports and review of literature. World J Clin Cases 2022; 10(10): 3268-3277 [PMID: 35647118 DOI: 10.12998/wjcc.v10.i10.3268]
Corresponding Author of This Article
Bin Zhao, MD, Chief Physician, Professor, Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China. zhaobin60@aliyun.com
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 6, 2022; 10(10): 3268-3277 Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3268
Emphysematous pyelonephritis: Six case reports and review of literature
Li-Ping Ma, Ning Zhou, Yan Fu, Yan Liu, Cong Wang, Bin Zhao
Li-Ping Ma, Yan Fu, Yan Liu, Cong Wang, Bin Zhao, Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
Ning Zhou, Department of Urology Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
Author contributions: Ma LP, Zhou N, Fu Y, Liu Y, Wong C and Zhao B contributed equally to this work; Ma LP and Zhou N designed the research study; Ma LP, Zhou N, Fu Y, Liu Y, Wong C and Zhao B performed the research; Ma LP wrote the manuscript; all authors have read and approve the final manuscript.
Informed consent statement: Informed consent was obtained from all patients and their families for publication of their clinical information and imaging studies in this study.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Zhao, MD, Chief Physician, Professor, Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China. zhaobin60@aliyun.com
Received: November 11, 2021 Peer-review started: November 11, 2021 First decision: December 27, 2021 Revised: January 11, 2022 Accepted: February 20, 2022 Article in press: February 20, 2022 Published online: April 6, 2022 Processing time: 137 Days and 24 Hours
Abstract
BACKGROUND
Emphysematous pyelonephritis (EPN) is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma, collecting system, or perinephric tissue and has a poor prognosis. EPN occurs primarily in people with diabetes mellitus (DM), but can occur in those without DM when the associated renoureteral unit is obstructed.
CASE SUMMARY
We describe our experience with six patients who developed EPN. Five patients had DM, including one with diabetic ketoacidosis, one with multisystem involvements, including eye, lung and brain. Bilateral urolithiasis was present in one case, along with emphysematous cystitis. Unilateral kidney stones were present in one patient. One patient was an older man in poor general health. Five individuals survived and underwent surgical procedures including ureteral stent installation (Double J stent placement), percutaneous nephrostomy and perinephric abscess puncture drainage, while one died because the patient’s family chose to terminate therapy. Klebsiella pneumoniae and Escherichia coli were the microorganisms implicated.
CONCLUSION
We conclude that EPN is a potentially fatal illness. A positive outcome necessitates early detection. Therapeutic measures should be implemented as soon as a diagnosis is made.
Core Tip: Emphysematous pyelonephritis (EPN) is a life-threatening kidney infectious disease. The incidence is not high. We report 6 cases of different types of EPN. Once diagnosed as EPN, we should take active and effective treatment according to the patient's condition at that time, so that patients can gain the greatest benefit.
