Emphysematous Pyelonephritis

Excerpt

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection that affects the upper urinary tract, involving the renal parenchyma and, in some instances, the perirenal tissues of the kidney. This condition frequently leads to gas formation in the renal parenchyma, collecting system, or perinephric tissue. Emphysematous pyelitis (gas in the renal pelvis) or emphysematous cystitis (gas within the bladder wall and lumen) may occur independently of associated EPN.

Diabetes mellitus represents the most prevalent risk factor, found in over 90% of patients diagnosed with EPN. EPN is a life-threatening disease, with reported mortality rates ranging from 40% to 90%. Clinical diagnosis of the condition closely mirrors acute pyelonephritis, which requires accurate evaluation through imaging, particularly computed tomography (CT) scans. Treatment options for EPN have evolved, with aggressive surgical intervention and more conservative therapeutic approaches, primarily involving percutaneous drainage and antimicrobials.