Emphysematöse pyelonephritis

Emphysematous pyelonephritis (EPN) represents a life-threatening infection of the renal parenchyma by gas-forming bacteria. Poorly controlled diabetes mellitus is present in up to 90% of patients. It carries a mortality rate of approximately 20%. The literature on EPN has been reviewed to develop a pathway to guide management of this rare condition. An analysis of 23 risk factors has for whom relatively conservative forms of treatment will be appropriate. Rarely, where the disease has an exceptionally fulminant course, urgent nephrectomy is lifesaving. All patients will require vigorous intravenousfluid replacement, broadspectrum antibiotics and diabetic control. Percutaneous drainage (PCD) is sometimes urgently required. Paradoxically, more localized parenchymal infection with little or no fluid collection (Wan "Type 1") may be predictive of poor outcome. The sinister implications of two other factors, thrombocytopenia, presumably as an indicator of septic disseminated intravascular coagulopathy (DIC), and bilateral disease are predictable.