Article metrics

  • citations in SCindeks: 0
  • citations in CrossRef:0
  • citations in Google Scholar:[=>]
  • visits in previous 30 days:12
  • full-text downloads in 30 days:1
article: 3 from 4  
Back back to result list
Vojnosanitetski pregled
2017, vol. 74, iss. 12, pp. 1170-1173
article language: English
document type: Case Report

Creative Commons License 4.0
Emphysematous pyelonephritis: Case report and review of literature
aClinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad + University of Novi Sad, Faculty of Medicine
bUniversity of Novi Sad, Faculty of Medicine + Clinical Center of Vojvodina, Center for Radiology, Novi Sad
cUniversity of Novi Sad, Faculty of Medicine + Clinical Center of Vojvodina, Clinic for Urology, Novi Sad



Introduction. Emphysematous pyelonephritis (EPN) is a severe, potentially fatal necrotizing infection of the kidney with the clinical picture ranging from the mild abdominal pain and discomfort to the septic shock and multiorgan failure. We presented here a case of EPN in a poorly controlled diabetic patient that was the first registered case of EPN in our clinic for more than ten years. Case report. A 78-year-old diabetic male patient was referred to the Clinic for Nephrology and Clinical Immunology of the Clinical Center of Vojvodina, Novi Sad, Serbia, with weakness, malaise, abdominal discomfort and reduced daily urine volume. After complete physical exam, laboratory work up, echosonographic and computed tomography scanning we diagnosed the patient with EPN class IV, according to the Huang and Tseng classification, with the presence of 5 risk factors for mortality (systolic blood pressure below 90 mmHg, altered consciousness, thrombocytopenia, elevated serum creatinine level, bilateral disease). Treatment with conservative therapy and percutaneous drainage was not successful, further deterioration of the patient status ensued so the patient passed away on the 8th day of hospitalization due to the development of septic shock with multiorgan failure that was refractory to all measures that were instituted. Conclusion. EPN is a severe, potentially fatal necrotizing inflammation of the kidney and surrounding tissue. Management and prognosis of this disease depends on the clinical status, risk factors and radiological classification of the disease.



Evanoff, G.V., Thompson, C.S., Foley, R., Weinman, E.J. (1987) Spectrum of gas within the kidney: Emphysematous pyelonephritis and emphysematous pyelitis. Am J Med, 83(1): 149-54
Falagas, M.E., Alexiou, V.G., Giannopoulou, K.P., Siempos, I.I. (2007) Risk factors for mortality in patients with emphysematous pyelonephritis: A meta-analysis. J Urol, 178(3 Pt 1): 880−5; quiz 1129
Huang, J., Tseng, C. (2000) Emphysematous Pyelonephritis. Archives of Internal Medicine, 160(6): 797
Hudson, M.A., Weyman, P.J., van der Vliet, A.H., Catalona, W.J. (1986) Emphysematous Pyelonephritis: Successful Management by Percutaneous Drainage. Journal of Urology, 136(4): 884-886
Kalathia, J., Chipde, S., Agrawal, S., Agrawal, R. (2015) Nephron-sparing surgery in case of emphysematous pyelonephritis. Urology Annals, 7(4): 504
Kangjam, S.S., Irom, K.S., Khumallambam, I.S., Sinam, R.S. (2015) Role of conservative management in emphysematous pyelonephritis: A retrospective study. J Clin Diagn Res, 9(11): PC09−11
Kapoor, R., Muruganandham, K., Gulia, A.K., Singla, M., Agrawal, S., Mandhani, A., Ansari, M.S., Srivastava, A. (2010) Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis. BJU international, 105(7): 986-9
Kelly, H. A. (1898) Pneumaturia. Journal of the American Medical Association, XXXI(8): 375
Khaira, A., Gupta, A., Rana, D.S., Gupta, A., Bhalla, A., Khullar, D. (2009) Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis. International Urology and Nephrology, 41(4): 959-966
Michaeli, J., Mogle, P., Perlberg, S., Heiman, S., Caine, M. (1984) Emphysematous Pyelonephritis. Journal of Urology, 131(2): 203-208
Schultz, E.H., Klorfein, E.H. (1962) Emphysematous Pyelonephritis. Journal of Urology, 87(6): 762-766
Shokeir, A.A., El-Azab, M., Mohsen, T., El-Diasty, T. (1997) Emphysematous pyelonephritis: a 15-year experience with 20 cases. Urology, 49(3): 343-6
Somani, B.K., Nabi, G., Thorpe, P., Hussey, J., Cook, J., n`Dow James (2008) Is Percutaneous Drainage the New Gold Standard in the Management of Emphysematous Pyelonephritis? Evidence From a Systematic Review. Journal of Urology, 179(5): 1844-1849
Tang, H.J., Li, C.M., Yen, M.Y., Chen, Y.S., Wann, S.R., Lin, H.H., i dr. (2001) Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect, 34(2): 125-30
Wan, Y.L., Lee, T.Y., Bullard, M.J., Tsai, C.C. (1996) Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology, 198(2): 433-438