Emphysematous pyelonephritis: one case report and analysis of 89 cases from published literature
10.3969/j.issn.1009-8291.2025.06.008
- VernacularTitle:气肿性肾盂肾炎1例报告并文献89例分析
- Author:
Lei HU
1
,
2
;
Jianfu ZHOU
3
;
Zhichao WANG
3
;
Haoqiang CHEN
1
;
Xuehua LIU
3
;
Songtao XIANG
3
Author Information
1. The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405
2. Department of Urology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510370, China
3. Department of Urology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510370, China
- Publication Type:Journal Article
- Keywords:
emphysematous pyelonephritis;
type 2 diabetes;
Escherichia coli;
drainage;
nephrectomy
- From:
Journal of Modern Urology
2025;30(6):497-503
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To explore the clinical features, treatment and prognosis of emphysematous pyelonephritis (EPN), so as to enhance the clinical awareness of this disease. Methods: A retrospective analysis was conducted on the clinical data of one EPN patient at The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, and a literature review was performed on articles published in the China National Knowledge Infrastructure and PubMed databases from Jan.1, 2015 to Dec.31, 2024. Results: The patient, a 62-year-old male with a 5 years' history of type 2 diabetes, was admitted due to left flank pain for 4 days, with a temperature of 39.4 ℃.Laboratory tests indicated significantly elevated inflammatory markers, decreased platelet count, and abnormal coagulation function.Preoperative blood and urine cultures showed positivity for Escherichia coli.Computed tomography (CT) revealed complete erosion of the left kidney, with gas in the left ureter and surrounding effusion, as well as multiple free gas in the abdominal cavity, bilateral ureteral stones, right renal lower calyx stones.After a multidisciplinary consultation, he underwent emergency phase Ⅰ left pyeloplasty and perirenal drainage with ureteral stenting.After discharge, the patient received maintenance hemodialysis once every two days in the outpatient clinic.One week after-discharge, the patient was readmitted due to polypnea.Following symptomatic management, vital signs stabilized.Approximately 2 months after the first-stage surgery, ureteroscopic stone extraction was successfully performed.One month after the stone extraction procedure, a follow-up CT showed normalization of the left kidney, renal pelvis and calyces, leading to phase Ⅱ laparoscopic left nephrectomy via the abdominal approach, with postoperative pathology indicating renal necrosis.Among 89 EPN patients reported in 35 articles, the median age was 58(24-92) years old；there were 59（66.3%） females and 30（33.7%） males；fever was the most common clinical symptom (60.7%)；73(82.0%) had diabetes, 12 (13.5%) had urinary tract obstruction；55 (61.8%) were infected with Escherichia coli, and 7 (7.9%) were infected with Klebsiella pneumoniae; 13 died due to ineffective treatmen. Conclusion: EPN presents acutely and progresses rapidly, often leading to misdiagnosis due to the lack of specific early symptoms.Abdominal CT is the preferred imaging modality for rapid diagnosis, and proactive interdisciplinary intervention can improve survival rates, reduce the need for nephrectomy, and enhance prognosis.
