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Hinyokika Kiyo 2021 Apr;67(4):147-152

The Department of Urology, Muroran City General Hospital.

We report a rare case of necrotizing fasciitis in the thigh induced by emphysematous pyelonephritis due to a staghorn stone. A 60-year-old female was diagnosed with a staghorn stone in the right kidney at another clinic. We referred her to another hospital for indication of percutaneous nephrolithotripsy. Read More

Medicina (Kaunas) 2021 May 26;57(6). Epub 2021 May 26.

Department of Urology, College of Medicine, Kyung Hee University, Seoul 02447, Korea.

To investigate the risk factors for emphysematous cystitis (EC) compared to those of acute cystitis (AC) to increase clinicians awareness of the possibility for the aggravation of patient status. We retrospectively reviewed a total of 54 patients who were hospitalized with a diagnosis of EC by abdominal computed tomography (CT) scan from 2006 to 2020. The control group included 92 patients who were hospitalized for the treatment of AC in the same period. Read More

World J Clin Cases 2021 Apr;9(11):2584-2594

Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China.

Background: Emphysematous pyelonephritis (EPN) is a rare but fatal necrotic infection of the kidney, which usually leads to septic shock. Therefore, early diagnosis and optimized therapy are of paramount importance. In the past two decades, point-of-care ultrasound (POCUS) has been widely used in clinical practice, especially in emergency and critical care settings, and helps to rapidly identify the source of infection in sepsis. Read More

J R Coll Physicians Edinb 2021 03;51(1):19-23

Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh.

Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN.

Methods: This retrospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between 2014 and 2020. Read More

J Bras Nefrol 2021 Mar 24. Epub 2021 Mar 24.

Universidade Estadual do Oeste do Paraná (Unioeste), Centro de Ciências Médicas e Farmacêuticas (CCMF), Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brasil.

Emphysematous pyelonephritis (EPN) is a rare acute necrotizing infection of the kidney and surrounding tissues, with gas in the renal parenchyma, collecting system or perirenal tissue. The bacterial etiology predominates; mainly Gram-negative bacilli; Candida spp. and C. Read More

BMJ Case Rep 2021 Feb 26;14(2). Epub 2021 Feb 26.

Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA

J Endourol Case Rep 2020 29;6(4):445-447. Epub 2020 Dec 29.

College of Medicine and Health Sciences, United Arab Emirates University and Mediclinic Al Ain, Al Ain, United Arab Emirates.

The presence of intra-calcular gas might indicate the coexistence of gas-forming bacterial infections, which are potentially severe and life threatening. Gas-containing renal stones are rare. Herein, we present a case of gas-containing renal matrix stone that was associated with emphysematous pyelitis and reflect on its management. Read More

AJR Am J Roentgenol 2021 03 13;216(3):812-823. Epub 2021 Jan 13.

Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH.

The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement. Read More

Trop Doct 2021 Jan 7:49475520983641. Epub 2021 Jan 7.

Professor, Department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh.

Emphysematous pyelonephritis is a rare, severe form of necrotising infection of the kidneys and peri-nephric tissues with gas accumulation, occurring predominantly among patients with diabetes mellitus. Computed tomography scan can identify the distribution of gas in the affected reno-ureteral units and so establish and classify the diagnosis. We report a case of class 4 emphysematous pyelonephritis with emphysematous cystitis, occurring in a young Bangladeshi male, who presented with features of upper urinary tract infection. Read More

Medicina (Kaunas) 2021 Jan 1;57(1). Epub 2021 Jan 1.

Radiology department, Urology and Nephrology Center, Mansoura University, 35516 Mansoura, Egypt.

There are many acute and chronic infections affecting the urinary tract including bacterial, fungal and viral infections. Urinary tract infections (UTIs) can present in many different patterns with variable degrees of severity varying from asymptomatic and uncomplicated forms to life threatening complicated infections. Cross-sectional imaging techniques-including both computed tomography (CT) and magnetic resonance imaging (MRI)-have become very important tools not only for evaluation of UTIs, but also for detection of associated complications. Read More

PLoS One 2020 31;15(12):e0244870. Epub 2020 Dec 31.

Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Objective: Previous studies on diagnostic accuracy of dipstick testing for leukocyte esterase (LE) and nitrite to diagnose urinary tract infection (UTI) had used urine culture, which is an imperfect gold standard. Estimates of diagnostic accuracy obtained using the classical gold standard framework might not reflect the true diagnostic accuracy of dipstick tests.

Methods: We used the dataset from a prospective, observational study conducted in the emergency department of a teaching hospital in southern India. Read More

Urologiia 2020 12(6):118-121

Department and Clinic of General Surgery of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia.

Emphysematous pyelonephritis is rare form of pyelonephritis, which has mortality of nearly 80%. Conservative treatment can be successful in less than 30% of cases. Currently, in the guidelines there is no standard approach to conservative and surgical treatment of this entity. Read More

Medicina (B Aires) 2020 ;80(6):703

Servicio de Clínica Médica, Sanatorio Güemes, Buenos Aires, Argentina.

Radiol Med 2021 Apr 27;126(4):505-516. Epub 2020 Nov 27.

Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.

Purpose: This article reviews imaging manifestations of complicated pyelonephritis associated with chronic renal stones disease, in particular xanthogranulomatous pyelonephritis (XGP) and emphysematous pyelonephritis (EPN), as potential mimics of other renal diseases and malignances and provides helpful tips and differentiating features that may alert the radiologist to suspect a diagnosis of infection.

Materials And Methods: A retrospective review of the records from 6 adult patients (5 females and 1 male, mean age 72,3 years) with diagnosis of XGP associated with chronic nephrolithiasis and 7 adult patients (6 females and 1 male, mean age 59,3 years) with diagnosis of EPN associated with chronic nephrolithiasis from January 2010 to January 2020 was carried out. Computed tomography urography (CTU) with at least an unenhanced scan, and the parenchymal and excretory phases after contrast medium administration performed at our Teaching Hospital were included. Read More

Urol Case Rep 2020 Nov 18;33:101353. Epub 2020 Jul 18.

Senior Specialist, Urology Department, IMC Hospital Jeddah, 2172, Saudi Arabia.

Emphysematous Pyelonephritis is a rare necrotizing infection with gas production and a high overall mortality rate. An elderly diabetic male patient presented to our Emergency Department with septic shock and was found to have left perinephric emphysematous pyelonephritis with a large collection. He was managed with the proper antibiotic therapy, and two trials of percutaneous drainage of the collection with no significant reduction in the size of the abscess. Read More

Case Rep Urol 2020 28;2020:8828289. Epub 2020 Sep 28.

Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26505, USA.

Background: Fungemia due to obstructive urinary tract fungal ball is exceedingly rare. These patients often have multiple predisposing conditions, including diabetes or antimicrobial exposure. While candiduria can be relatively common in this population, urinary tract fungal balls are a rare entity. Read More

Am J Case Rep 2020 Sep 20;21:e922974. Epub 2020 Sep 20.

2nd Department of Internal Medicine, "A. Fleming" General Hospital, Athens, Greece.

BACKGROUND Emphysematous pyelonephritis (EPN) is a life-threatening infection of the renal parenchyma. The purpose of this report is to present a case of EPN with distinctive imaging. CASE REPORT An 87-year-old man with a history of type 2 diabetes mellitus presented to the ER with fever and shivering, hypotension, and anuria, which is a clinical presentation of septic shock. Read More

BJU Int 2021 Apr 15;127(4):418-427. Epub 2020 Oct 15.

Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.

Objectives: To define pre-morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.

Patients And Methods: From January 2009 to December 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non-contrast computed tomography of the abdomen and those diagnosed with EPN were included in this study. Read More

Radiol Clin North Am 2020 Sep 14;58(5):909-923. Epub 2020 Jul 14.

Mayo Clinic School of Medicine, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.

Acute pyelonephritis is a bacterial infection of the renal parenchyma and collecting system. Diagnosis is based on clinical findings of fever, flank pain, and urinary tract infection. Computed tomography findings include renal enlargement with wedge-shaped heterogeneous areas of decreased enhancement, known as a "striated nephrogram. Read More

BMC Urol 2020 Jan 29;20(1). Epub 2020 Jan 29.

Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, 361004, Fujian, China.

Background: The management of emphysematous pyelonephritis (EPN) includes conservative medical treatment, percutaneous drainage, and surgical resection of the involved kidney. EPN with diabetic ketoacidosis(DKA) is very rare, in which the clinical management of refusing surgical drainage is inexperienced.

Case Presentation: A 34-year-old woman presented with abdominal pain, chills, fever, nausea, vomiting, chest tightness, and shortness of breath. Read More

Saudi J Kidney Dis Transpl 2019 Nov-Dec;30(6):1485-1487

Department of Nephrology Dialysis and Renal Transplantation, Civico and Di Cristina Hospital, Palermo, Italy.

Am J Case Rep 2019 Dec 2;20:1793-1796. Epub 2019 Dec 2.

Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece.

BACKGROUND Emphysematous osteomyelitis of the spine is characterized by intravertebral or intraosseous air. Emphysematous pyelonephritis (EP) is the infection of the renal parenchyma and perirenal tissues caused by gas forming microorganisms and thus is characterized by gas formation. Prompt diagnosis and initiation of necessary treatment is crucial, as both entities are associated with high mortality rates. Read More

Intern Emerg Med 2020 01 7;15(1):149-150. Epub 2019 Nov 7.

Internal Medicine Department, Hospital Universitario, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero 1500, Mitras Centro, 64460, Monterrey, Nuevo León, Mexico.

Can Assoc Radiol J 2019 Nov 17;70(4):424-433. Epub 2019 Sep 17.

Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. Electronic address:

Purpose: To review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis.

Conclusion: Acute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Read More

Clin Med (Lond) 2019 09;19(5):421-422

Division of Advanced Internal Medicine, National University Hospital, Singapore.

BMJ Case Rep 2019 Sep 12;12(9). Epub 2019 Sep 12.

Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Pondicherry, India.

Emphysematous pyelonephritis (EPN) can present with symptoms due to infection or sepsis. EPN presenting with renal vein and inferior vena cava (IVC) thrombus is very rare. We report a case of EPN with renal vein and IVC thrombus and its management. Read More

Int Urol Nephrol 2019 Oct 15;51(10):1709-1713. Epub 2019 Jul 15.

Mefrek Hospital, Abu Dhabi, United Arab Emirates.

Purpose: In view of the differences in early and late management experiences based on Huang and Tseng CT classification of emphysematous pyelonephritis (EP), our study included 34 patients aimed to re-correlate the current management plans with CT classification.

Methods: A retrospective review from January 2009 to December 2018, in patients with primary or final diagnosis of EP. Data included; patients' demographics, routine laboratory and imaging work-up. Read More

Clin Exp Nephrol 2019 Oct 3;23(10):1257-1258. Epub 2019 Jul 3.

Division of Nephrology, University of Texas At San Antonio, 7703 Floyd Curl Dr, MC 7882, San Antonio, TX, 78229, USA.

Saudi J Kidney Dis Transpl 2019 May-Jun;30(3):706-709

Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia.

Diabetes mellitus (DM) is a common disease in Oman as in rest of Gulf Cooperation Council where metabolic syndrome is of high prevalence. DM is a foremost risk factor for urinary tract infections (UTIs). It is also linked to more complicated infections such as emphysematous pyelonephritis (EPN), emphysematous pyelitis (EP), renal/perirenal abscess, emphysematous cystitis, xanthogranulomatous pyelonephritis, and renal papillary necrosis. Read More