Is aggressive therapy the answer for all cases of emphysematous pyelonephritis: a report of three cases

Abstract

Emphysematous Pyelonephritis (EPN) is a severe, necrotizing, life threatening infection of the renal parenchyma and management is not standardised due to scarcity of literature. We present 3 patients with this rare entity. All 3 patients were of class III on CECT findings based on Huang's classification and had more than two risk factors. Our first patient underwent percutaneous drainage of his condition upon which he recovered. The second and third patients underwent a laparotomy and nephrectomy. The second patient recovered after a stormy post operative period and the third patient died. Management of the first patient was contrary to that recommended in literature, for the other two it was as per recommendations. On successful management of our first patient without surgery and seeing no discernable benefits of surgery for our other two patients, it is possible that percutaneous drainage alone, coupled with antibiotics may be a viable strategy for managing this condition with nephrectomy being considered as a second tier option.

Keywords: Emphysematous; life threatening; necrotizing; nephrectomy; pyelonephritis.

Figure 1

CECT with coronal reconstruction showing emphysematous pyelonephritis of left kidney

Figure 2

CECT showing emphysematous pyelonephritis of left kidney

Figure 3

CECT showing emphysematous pyelonephritis of right kidney

Figure 4

CECT with coronal reconstruction showing emphysematous pyelonephritis of right kidney