Emphysematous pyelonephritis Diagnosis Radiology Prognostic factors Management

1. Emphysematous
pyelonephritis
Sukhdev, CMC Vellore

2. Etymology
• 1962, Klorfein and Schultz coined the term
• Older terms : renal emphysema, penumonephritis

3. Associated factors
• 95% of EPN patients will have Diabetes
• 25-40% of patients with urinary tract obstruction will develop EPN
• Females:Males = 6:1

4. Mortality
• 21%
• Nephrectomy in an EPN still has a mortality rate of 6%

5. Microbiology
• E coli most common
• Others: Klebsiella, Proteus and rarely – candida, clostridium
• 50% of EPN patients present with bacteremia

6. Diabetes and EPN
• High glucose levels α High tissue fermentation
• Impaired blood supply to kidneys in Diabetics
• And so, impaired immune response influx

7. Radiological Classification

8. • Type 1 of EPN is emphysematous pyelitis
• Excellent prognosis
• Usually associated with urinary tract instrumentation

9. Prognostic factors
• Systolic BP<90
• AKI
• Decreased mental state
• Thrombocytopenia
• Bilateral involvement

10. Management
*Risk factors:
1. AKI
2. Thrombocytopenia
3. Shock
4. Confusion
5. Diabetes