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We report co-occurrence of emphysematous cystitis and emphysematous pyelonephritis (EC/EPN) in a 64-year-old female with poor-controlled diabetes mellitus (DM) that presented with flank pain, fever, and hematuria that turned out to have a bilateral extrarenal pelvis. On examination, she was feverish, and the costovertebral angle was tender. By considering herhemoglobin A1C, her DM was out of control. Inflammatory markers elevated. Renal function tests were impaired. Urine culture was positive for extended-spectrum beta-lactamase Escherichia coli. Computed tomography scans (CT) confirmed the presence of air in the bladder and renal pelvis in favor of EC and unilateral EPN. We planned to use conservative treatments. Promptly intravenous antibiotics started; thereafter, the renal pelvis was drained via percutaneous catheter, and the bladder was drained via foley catheter, as well. After 14 days of hospitalization, clinical status improved, urine culture got negative, and emphysema in follow-up CT images wholly regressed. To our knowledge, co-occurrence of emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) in a patient with an extra renal pelvis never happened. We tend to convey messages, including (1) the extrarenal pelvis may contribute to predisposing the patient to pyelonephritis if it is considerably large; (2) the conservative plan and observation was a successful experience in treating extrarenal pelvis patients with EC/EPN., (© 2023. The Author(s), under exclusive licence to Japanese Society of Nephrology.)

Purpose: Emphysematous pyelonephritis (EPN) is an acute, severe necrotising infection of the kidney. There has been a shift from early nephrectomy to conservative methods. We conducted a meta-analysis to assess the impact of risk factors and treatment choices on outcomes in EPN., Methods: We conducted a database search of all studies in English, reporting more than 12 patients of EPN from 1980 to 2020. We compiled the demographics, clinical presentations, risk factors, critical diagnostic results, treatment modalities and outcomes, including mortality., Results: We identified 37 observational studies, 32 retrospective and 5 prospective. The studies reported on 1146 patients, of which 790(68.9%) were female, and 946 (82.5%) were diabetic. In addition, 184 (16.1%) patients had stones, and 235 (20.5%) had obstructive uropathy. Fever and flank pain were the most frequent symptoms. The most common clinical features were pyuria, fever, flank tenderness, and tachycardia. E. coli, Klebsiella pneumoniae and Proteus were the most frequent organisms isolated. X-ray KUB and ultrasound were used as initial diagnostic modalities, but CT scan was the usual diagnostic and confirmatory investigation. Confusion, shock, thrombocytopenia, sepsis, emergency nephrectomy and hyponatremia were significantly associated with mortality. In particular, confusion and hyponatremia were associated with a sevenfold increase in mortality risk. There was no evidence that diabetes, stones, obstructive uropathy, AKI or proteinuria was associated with higher mortality. Nevertheless, 143 of the total 1146 patients died (12.5%). While 26% of the patients who had upfront emergency nephrectomy died, only 9.7% and 10% of patients with medical management and medical management plus minimally invasive treatments died. However, patients that failed medical and minimally invasive treatments and needed salvage emergency nephrectomy had a mortality of upwards of 27%., Conclusion: The risk factors for mortality in emphysematous pyelonephritis are shock, thrombocytopenia, confusion, hyponatremia and emergency nephrectomy. Conservative and minimally invasive treatment should be the initial management strategy for emphysematous pyelonephritis as they carry lesser mortality risks. The presence of risk factors may help predict the subset of patients who need aggressive treatment and minimally invasive treatment modalities or early nephrectomy., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To analyse the incidence and management of emphysematous pyelonephritis (EPN) in North West London and examine factors that influence immediate and 6-month outcomes with the aim of guiding future management., Methods: This work analyses EPN cases from the London North West Healthcare NHS Trust from October 2006 to July 2015 (population ≈ 850,000). Diagnosis and stage were confirmed by computed tomography (CT). Demographic, clinical, biochemical and microbiological characteristics were assessed. Treatment modalities were medical management, minimally invasive management (MIM) and surgical. Immediate and 6-month outcomes were analysed., Results: Thirteen cases were identified (f = 8, m = 5) from 5525 CT scans. EPN occurred in patients with diabetes mellitus (n = 11, 84.6%), hypertension (n = 10, 76.9%) or urinary tract calculi (n = 7, 53.85%). Unilateral EPN occurred predominantly (n = 11, 84.6%); 46.1% (n = 6) were class 1 or 2 and 53.8% (n = 7) class 3 or 4. Escherichia coli was most commonly cultured (n = 5, 38.46%). All patients received antibiotics, and ten cases required MIM. Two patients had a delayed nephrectomy, both survived. Mortality was 15.4% (n = 2, grade 1 and 3a), both died acutely post-MIM, neither underwent emergency nephrectomy. At 6 months, eight patients had ongoing renal impairment. No specific poor prognostic factors were identifiable., Conclusions: Patients with low-grade EPN may also have a high mortality rate. In the two cases who died, earlier consideration for nephrectomy may have been prudent. It may be beneficial to have a low threshold for prompt emergency nephrectomy in severe cases and where MIM treatment has failed. We suggest a management algorithm to guide clinicians and minimise mortality.

Key Clinical Message: Case report summary: A 9–year‐old male castrated domestic shorthair feline was presented to the emergency department with a chief complaint of constipation of 3‐day duration, decreased urination of 1‐day duration, vomiting, and hind limb weakness. Physical examination abnormalities included hypothermia, dehydration, and generalized paresis with inability to stand for a prolonged period of time. Abdominal ultrasonography showed pinpoint hyperechoic foci throughout the hepatic parenchyma, small gas foci circulating within the portal vasculature consistent with emphysematous hepatitis, and mild volume of ascites. Cytology of the ascites was consistent with inflammatory effusion. Hepatic cytology was consistent with mixed inflammation/hepatitis with no apparent cause for inflammation noted. Urine culture yielded a negative result. Surgical liver biopsy and culture were declined by the patient's family. Ultrasound changes were presumed to be most likely secondary to an ascending infection. [ABSTRACT FROM AUTHOR]

Mucormycosis is a rare disease. It is typically seen in immunocompromised patients. Isolated renal mucormycosis is an extremely rare disease. We here report a case of isolated renal mucormycosis who had recently recovered from COVID-19 pneumonia. The patient was a known case of diabetes mellitus and had already developed acute kidney injury when he reported to us. Despite aggressive medical and surgical management, the patient succumbed to the disease.

Lower limb restriction is usually due to any pathology affecting the joints or neurological causes. Emphysematous pyelonephritis is caused by gas-producing anaerobes and is one of the life-threatening diseases. It can extend into various fascial planes can be seen causing multiple ranges of symptoms. A 49-year-old male patient came with complaints of difficulty in extending the left lower limb for the past 1 month with associated left loin pain radiating to the left lower limb. Plain CT KUB shows features suggestive of bilateral emphysematous pyelonephritis with left retro-renal multi-loculated collection with extension of infection into anterior abdominal wall fascia and inferiorly into the left pelvic muscles and left thigh. Emphysematous pyelonephritis presenting as necrotizing fasciitis is a rare phenomenon. Patients with uncontrolled diabetes can clinically present with both these entities. Necrotizing fasciitis of the thigh leading to restriction of movement in the lower limb can sometimes be the cardinal clinical and odd presentation of emphysematous pyelonephritis.

A 56-year-old man, diabetic and hypertensive, who came to the emergency department with a one-week evolution of polakiuria and pneumaturia, under Ciprofloxacin for suspected urinary tract infection. On objective examination, he presented hemodynamically stable, apyretic, with pain in the right flank and in the right iliac fossa, without signs of peritoneal irritation. Murphy's sign was present on the right. Analytically with elevation of inflamatory parameters and slight elevation of transaminases. Renal function was preserved. An Uro-CT was performed showing evidence of marked pyelo-kalicial dilatation of the right kidney, with marked reduction in parenchymal thickness and significant delay in the concentration of excretion of the contrast product, with the presence of air-fluid level in the pelvis, in the context of an abscessed emphysematous pyelonephritis. Cultures were taken and broad-spectrum antibiotic therapy was started. Percutaneous ultrasound-guided nephrostomy was performed. Microbiological study was negative. With clinical improvement under prescribed antibiotic therapy. Subsequently, renal scintigram was performed and showed abcense of function of the right kidney. The patient was proposed for a total right nephrectomy by laparoscopic approach. Discussion: Emphysematous pyelonephritis is a rare infection of the renal parenchyma characterized by gas production, usually by gram-negative, facultatively anaerobic microorganisms. Of the cases described, 60% to 70% are associated with poorly controlled diabetes mellitus. Although the presentation is often similar to uncomplicated pyelonephritis, the clinical course is severe with a high early mortality rate, about 75% with medical treatment alone and 45% with medical and surgical treatment.

Mrs. E. J. N is a 57-year-old Type II diabetic who presented to the emergency unit of internal medicine with a 1-week history of reduction in urine output and passage of foul-smelling urine with associated fever, nausea, vomiting, and right flank abdominal pain. This clinical case was diagnosed as emphysematous pyelonephritis with the help of ultrasonography. She recovered with medical therapy. This case highlights that aggressive medical management in severe cases may obviate the need for potentially dangerous surgical interventions in resource-limited settings.

Emphysematous Pyelonephritis (EP) is a rare necrotizing renal parenchymal infection characterised by gas within the kidney parenchyma. Management with emergency nephrectomy has transitioned to a graded medical, radiological intervention and surgical approach. We present a rare case of high-risk emphysematous pyelonephritis, outlining key high risk factors and demonstrating staggered care escalation within a rural Australian referral hospital.

We report a case of cooccurrence of xanthogranulomatous and emphysematous pyelonephritis along with necrotizing fasciitis (NF) of scrotum and premium in a patient was nondiabetic and the history of kidney stones. This case a unique presentation of NF due to two pyelonephritis causing fournier gangrene. Surgical management and antibiotics provide an effective management of the disease.

Context: Emphysematous pyelonephritis (EPN) is an acute necrotizing inflammation of renal parenchyma and peri-nephric tissue characterized by gas formation. In this study, we evaluated the outcome of EPN cases by medical management with or without renal decompression. Materials and Methods: We have observed prospectively 15 cases of EPN admitted in our institute in respect to age, sex, mode of presentation, presence of comorbidity, laboratory profile, urine-analysis, and outcome after medical management and drainage procedures. Results: All patients improved on medical management and drainage procedure such as JJ stenting and percutaneous nephrostomy. No mortality noted in our 15 cases of EPN. Conclusion: Emphysematous pyelonephritis can be managed conservatively by DJ stenting, wcich is a less morbid procedure or percutaneous nephrostomy with proper antibiotics and adequate glycemic control.

Association of emphysematous pyelonephritis (EPN) with horseshoe kidney is rare. It is a life-threatening condition with variable mortality. Historically, the treatment consisted of early nephrectomy. One such patient managed conservatively by placement of percutaneous drainage (PCD) and appropriate antibiotic coverage, is reported. This patient responded well to the conservative approach of treatment by insertion of PCD under computed tomography guidance. Hence, insertion of PCDs is an effective way of treating EPN.

Diabetes mellitus increases the risk of infection, especially when poorly controlled. Prolonged hyperglycemia promotes bacterial growth leading to infection, such as urinary tract infections (UTIs), and eventually leads to bladder dysfunction and irreversible kidney damage. The use of a minimally invasive glucometer will increase glycemic control and reduce the incidence of UTIs and other sequalae. [ABSTRACT FROM AUTHOR]

Context: Emphysematous pyelonephritis (EPN) is an acute necrotizing inflammation of renal parenchyma and peri-nephric tissue characterized by gas formation. In this study, we evaluated the outcome of EPN cases by medical management with or without renal decompression. Materials and Methods: We have observed prospectively 15 cases of EPN admitted in our institute in respect to age, sex, mode of presentation, presence of comorbidity, laboratory profile, urine-analysis, and outcome after medical management and drainage procedures. Results: All patients improved on medical management and drainage procedure such as JJ stenting and percutaneous nephrostomy. No mortality noted in our 15 cases of EPN. Conclusion: Emphysematous pyelonephritis can be managed conservatively by DJ stenting, wcich is a less morbid procedure or percutaneous nephrostomy with proper antibiotics and adequate glycemic control. [ABSTRACT FROM AUTHOR]

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the kidney characterized by the presence of gas in the renal parenchyma, collecting system or perinephric tissues. It can be life-threatening if not recognized and treated promptly. We report the case of a 56-year-old woman, on treatment for diabetes mellitus, who presented with left-sided flank pain and fever. Computerized tomography revealed EPN with extensive destruction of the left kidney. Intravenous antibiotics were administered and left nephrectomy was performed. The postoperative course was uncomplicated, but during 4 months follow-up the patient's renal function rapidly deteriorated. This case report emphasizes the need for appropriate management of EPN.

Abstract: Emphysematous pyelonephritis is a severe, acute necrotizing renal parenchymal and perirenal infection with formation of gas. Emphysematous pyelonephritis predominantly affects females with uncontrolled diabetes and can occur in insulin-dependent as well as non-insulin dependant patients. CT scan is the modality of choice for the staging of the parenchymal gas and to rule out obstruction. We present a case of 83-year old female with uncontrolled diabetes mellitus who presented with dysurea and right flank pain in the emergency department. She was diagnosed as a case of emphysematous pyelonephritis. She was treated successfully in the urology department by antibiotics and percutaneous drainage. [ABSTRACT FROM AUTHOR]

The article discusses research on how emphysematous pyelonephritis can lead to end-stage renal failure. It references a study by John A. Sayer of the Institute of Human Genetics of Newcastle University in Newcastle Upon Tyne, published in the February 14, 2008 issue of "NDT Plus." The researchers studied a 63-year-old woman, whose health deteriorated developing respiratory failure and anuric kidney injury. They found that managing this condition requires various methods like nephrectomy.

Summary: Objectives: To report three cases of emphysematous prostatic abscess (EPA) and review the literature on this rare entity. Methods: All relevant articles published in English over the last 50 years (1961–2011) were identified using a MEDLINE search for keywords ‘emphysematous prostatitis’ and ‘emphysematous prostatic abscess’. A total of 12 patients were evaluated for their age, race, underlying disease, pathogens, diagnosis tool, treatment options, and clinical outcome. Results: EPA is a high mortality disease (25%) and has an association with diabetes mellitus. The most common pathogen in the 12 cases was Klebsiella pneumoniae. Conclusions: The mortality of EPA is higher than that of emphysematous cystitis and emphysematous pyelonephritis. Timely recognition and prompt drainage are very important. [ABSTRACT FROM AUTHOR]

Emphysematous pyelonephritis is a gaseous necrotizing renal infection with high mortality and morbidity. In most of the cases, patients have the history of diabetes mellitus. The disease usually presents with pyelonephritis unresponsive to treatment and is diagnosed with CT scan. Treatment usually requires surgery and antibiotics. In rare cases, patients have unusual presentation of the disease. Here, we report two patients with inguinal hernia symptoms and emphysematous pyelonephritis. [ABSTRACT FROM AUTHOR]