Search Our Scientific Publications & Authors

Urol Ann 2020 Apr-Jun;12(2):156-162. Epub 2020 Apr 14.

Department of Community Medicine, Kasturba Medical College, Mangalore, MAHE, Manipal, Karnataka, India.

Introduction: Emergency nephrectomy has been the time-honored treatment of choice for emphysematous pyelonephritis (EPN), a fatal gas-forming necrotizing infection. Recent years have seen a shift toward nonextirpative approach aimed to achieve higher rates of renal salvage, limiting the indications for nephrectomy to severe grades of the disease. This study aimed at analyzing the role of initial renal preserving measures algorithmically applied across grades of EPN. Read More

Indian J Crit Care Med 2020 Apr;24(4):281-282

Department of Urology, Sri Narayani Hospital and Research Centre, Vellore, Tamil Nadu, India.

Emphysematous pyelonephritis (EPN) is characterized by fulminant necrotizing infection of the kidney and perirenal tissues. Emphysematous pyelonephritis presenting as pneumomediastinum is quite rare. A 65-year-old gentleman presented to us with respiratory failure on ventilator support and uncontrolled sugars. Read More

Iran J Kidney Dis 2020 May;14(3):235-238

Department of Internal Medicine, Loghman- Hakim Hospital, Shahid Beheshti of Medical Science, Tehran, Iran.

The initial manifestation of emphysematous pyelonephritis (EPN) with hiccups is extremely rare. We report a 47-year-old diabetic man with complaint of persistent hiccups as the first manifestation. Class 3B EPN was confirmed based on findings of Contrast-enhanced abdominal multi-slice CT scan. Read More

Nephron 2020 28;144(6):304-309. Epub 2020 Apr 28.

Nephrology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain.

Emphysematous pyelonephritis (EPN) is a rare and serious necrotizing infection that is potentially life-threatening. It has been seldom reported in kidney grafts and is usually caused by Gram-negative bacteria, with some case reports caused by anaerobic bacteria, and has been closely associated with poorly controlled diabetes mellitus (DM) and urinary tract structural abnormalities. There are no reports of EPN of fungal etiology in kidney grafts. Read More

Can J Urol 2020 Apr;27(2):10195-10198

Division of Urology, University of Ottawa, Ottawa, Ontario, Canada.

Emphysematous pyelonephritis is a life-threatening, urologic emergency. We present the case of a 54-yearold female who was found to have a large volume of air in her renal vein and inferior vena cava from severe emphysematous pyelonephritis. In this case report, the medical and operative management of this patient are reviewed, and the literature on the management of emphysematous pyelonephritis is summarized. Read More

CEN Case Rep 2020 Apr 23. Epub 2020 Apr 23.

Department of Genetics and Molecular Biology, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV), Mexico, Mexico.

Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. Read More

Urol Case Rep 2020 Jul 2;31:101172. Epub 2020 Apr 2.

First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, China.

Kidney stones and Emphysematous Pyelonephritis with septic shocks is a critical and urgent occurrence has a high mortality rate, which needs to be paid great attention to. Early anti-infection and removal of obstruction play a key role in the treatment.This case report reviews the diagnosis and treatment of the case, discusses the disease characteristics of the disease, and shares our successful clinical experience in treating the disease. Read More

Lancet 2020 04;395(10230):1145

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.

World J Urol 2020 Feb 27. Epub 2020 Feb 27.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

Purpose: Infectious diseases that often follow geographical distribution patterns are increasingly crossing such boundaries, aided by human travel and commerce. These pose a new challenge to physicians who are required to diagnose previously unseen conditions and address drug-resistant organisms. We review some such common infections. Read More

Rev Urol 2019 ;21(4):175-177

Vice Chair of Urology, NYU School of Medicine New York, NY.

Urol Case Rep 2020 May 11;30:101113. Epub 2020 Jan 11.

Department of urology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia.

Emphysematous pyelonephritis (EPN) is an acute life-threatening gas-forming necrotizing infection of the renal parenchyma and its surrounding tissues. EPN requires early diagnosis and management because of related life-threatening septic complications. Gram-negative bacteria remain the most common causative organisms. Read More

Niger Postgrad Med J 2020 Jan-Mar;27(1):59-62

Department of Medicine, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria.

Emphysematous pyelonephritis (EPN) is a rare, severe necrotising infection of the renal parenchyma and surrounding tissues. It is usually life-threatening and should be promptly treated. Here, we report a clinical case of a 54-year-old male who presented with the left flank pains of 3-week duration. 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

Indian J Urol 2020 Jan-Mar;36(1):67-68

Department of Genitourinary Surgery, Government Medical College, Kottayam, Kerala, India.

Gas-containing renal stones is a rarely described complication of emphysematous pyelonephritis. Most of these patients are diabetic and almost all have urinary obstruction and stasis. Management of these patients may be associated with several complications. Read More

Case Rep Urol 2019 19;2019:8743525. Epub 2019 Dec 19.

Department of Urology, Lebanese Geitaoui Hospital, Beirut, Lebanon.

Emphysematous pyelonephritis (EPN) is a gas-producing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue. It is a life-threatening condition that requires a high index of suspicion, an early diagnosis and an aggressive treatment. Rapid progression to septic shock may occur. Read More

Pak J Med Sci 2020 Jan;36(1):S83-S86

Abdul Hafeez Qureshi, MBBS, FCPS. Senior Consultant, Urology Department, The Indus Hospital, Karachi, Pakistan.

Background And Objective: Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing renal parenchymal infection. Traditional management of EPN with nephrectomy had a mortality of 40-50%. The purpose of this case series was to assess the management, biochemical factors, and outcome of EPN patients. 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.

Saudi J Kidney Dis Transpl 2019 Nov-Dec;30(6):1266-1275

Department of Urology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.

Mortality among patients with emphysematous pyelonephritis (EPN) has reduced from 78% to 21%, yet it is one of the most serious urologic emergencies. This prospective observational study aims to study and compare clinical profile, management, and outcomes in diabetic and nondiabetic patients with EPN. All patients of EPN admitted to emergency medical services were included in the study. Read More

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

Sci Rep 2019 11 12;9(1):16618. Epub 2019 Nov 12.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

This study assesses the performance of National Early Warning Score (NEWS), Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) in predicting emphysematous pyelonephritis (EPN) patients' need for intensive care unit (ICU) admission. A retrospective analysis was conducted at four training and research hospitals' emergency departments (EDs) on all EPN adult patients from January 2007 to August 2017. Data extracted were used to calculate raw scores for five physiologic scoring systems. 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.

Urol Case Rep 2019 Nov 20;27:100780. Epub 2018 Oct 20.

Department of Urology, La Rabta University Hospital, Tunisia.

Urol Ann 2019 Oct-Dec;11(4):414-420

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

Objective: The objective of the study is to analyze the risk factors determining the outcomes of patients with emphysematous pyelonephritis (EPN) by the adoption of a standardized management algorithm as well as to develop a prognostic scoring model to risk stratify these patients.

Materials And Methods: The hospital records of 72 consecutive patients with EPN from February 2012 to January 2018 were retrospectively reviewed. Demographic, clinicoradiographic, and laboratory characteristics were recorded. Read More

Case Rep Emerg Med 2019 2;2019:6903193. Epub 2019 Sep 2.

Mount Sinai Medical Center, 4300 Alton Rd., Miami Beach, FL 33140, USA.

Emphysematous pyelonephritis (EPN) is a rare form of pyelonephritis causing a severe infection of the renal system that includes gas in the renal parenchyma, collecting system and surrounding tissue often presenting with sepsis. We report the case of a 60-year-old male with poorly controlled insulin dependent diabetes mellitus who presented with abdominal pain, nausea, vomiting, and "peeing air." CT scan revealed air extending from the left renal parenchyma, perinephric fat and into the bladder, consistent with emphysematous pyelonephritis. Read More

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

Cureus 2019 Jun 24;11(6):e4988. Epub 2019 Jun 24.

Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA.

Perinephric abscess is a known complication of urologic infection, sometimes requiring surgical debridement. Extension into adjacent structures is rarely reported. We present a case of a woman with xanthogranulomatous emphysematous pyelonephritis accompanied by massive perinephric abscess, resulting in celiac and splenic artery mycotic aneurysms via direct invasion. Read More

Urol Case Rep 2019 Sep 26;26:100962. Epub 2019 Jul 26.

Department of Surgery, Tuen Mun Hospital, Hong Kong.

Asymptomatic emphysematous pyelonephritis is a rare but potentially life-threatening disease. Diabetes mellitus is the most recognised risk factor. Aim of this case report is to review evidence of emphysematous pyelonephritis to identify risk factors and treatment options. Read More

Curr Urol 2019 May;12(3):134-141

Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan.

Introduction: We investigated relationships between therapeutic outcomes of patients with emphysematous pyelonephritis (EPN) and changes in the Sequential Organ Failure Assessment (SOFA) score.

Materials And Methods: We retrospectively evaluated EPN patients treated in our hospitals using the SOFA score incorporated in the Sepsis-3 updated in 2016.

Results: Seventeen typical EPN patients were included in this study, and were treated with medical management with no drainage (n = 3), retrograde stenting (n = 10), or percutaneous drainage (n = 3). 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

Indian J Med Res 2019 03;149(3):428-429

Department of Urology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605 006, India.

BMJ Case Rep 2019 Jun 20;12(6). Epub 2019 Jun 20.

MIOT International, Chennai, Tamil Nadu, India.

Urol Case Rep 2019 Sep 5;26:100934. Epub 2019 Jun 5.

Resident Urology,Armed Forces Institute of Urology(AFIU), Rawalpindi, Pakistan.

The present report describes the case of a 53-year-old male patient with solitary functioning right kidney admitted to the emergency room with acute abdominal pain, deranged blood sugar, and fever (38.5 °C). Laboratory investigations and computed tomography findings revealed urinary tract infection, deranged renal functions, raised inflammatory markers associated with the presence of gas in the collecting system, characterizing unilateral emphysematous pyelitis caused by Gram-negative bacteria. Read More

BMJ Case Rep 2019 Jun 5;12(6). Epub 2019 Jun 5.

Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA.

J Infect Chemother 2019 Oct 15;25(10):791-796. Epub 2019 May 15.

Uro-andrology Clinical Fellow, Urology and Nephrology Center, Mansoura University, Egypt. Electronic address:

Objectives: To study risk factors for sepsis and mortality evaluating the role of platelet to leucocytic count ratio (PLR) as a marker for urosepsis and clinical outcomes in cases of emphysematous pyelonephritis (EPN).

Materials: Patients with EPN were retrospectively reviewed. Patients' age, sex, diabetes mellitus (DM), Body Mass Index (BMI), hydronephrosis, types of EPN, air locules volume, serum creatinine, leucocytic count, and platelet count, PLR, albumin, INR and the line of treatment were analyzed as risk factors of sepsis. Read More

Urol Case Rep 2019 Jul 9;25:100887. Epub 2019 Apr 9.

King Abdulaziz University, Faculty of Medicine, Saudi Arabia.

Gas-containing stones are extremely rare. The formation of renal stones, including the presence of free gas within the stone, is overall poorly understood. The presence of free gas in the collecting system of the urinary tract indicates emphysematous pyelonephritis, in the absence of prior surgical intervention, gastrointestinal fistula, or urinary bladder catheterization. Read More

Indian J Med Res 2018 Dec;148(6):759-760

Department of Radiodiagnosis & Interventional Radiology, Amrita Institute of Medical Sciences & Research Centre, Kochi 682 041, Kerala, India.

BMJ Case Rep 2019 Feb 13;12(2). Epub 2019 Feb 13.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Front Pediatr 2019 24;7. Epub 2019 Jan 24.

Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing infection of the kidney. To date, very few cases of EPN have been described in the pediatric age. The first case of EPN in a toddler occurring after ureterovesical reimplantation for congenital obstructive megaureter is reported with a literature review. Read More

Indian J Nephrol 2018 Nov-Dec;28(6):454-461

Department of Nephrology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru, Karnataka, India.

Acute pyelonephritis (APN), although a common clinical entity, still not much is known about the clinical profile in the Indian scenario. We prospectively collected clinical, biochemical, and radiological data of patients hospitalized with a diagnosis of APN from March 2014 to June 2016. A total of 296 cases were included in the study. Read More

Perm J 2019 ;23:18-044

PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharshtra, India.

Introduction: We studied the value of neutrophil:lymphocyte ratio (NLR) in predicting the success of nephron-sparing procedures in management of emphysematous pyelonephritis.

Methods: In this single-center retrospective study, patients underwent nephron-sparing procedures between 2007 and 2014. Severity was graded by Huang-Tseng classification. Read More

Nihon Hinyokika Gakkai Zasshi 2019 ;110(2):134-137

Department of Urology, National Defense Medical College Hospital.

We report a case of a 53-year-old woman with emphysematous pyelonephritis who presented the preservation of the ipsilateral kidney following open drainage. She was transferred to our hospital with chief complaints of right back pain and high fever. On diagnosis, diabetes mellitus and a stone in the right ureter were confirmed, and she was followed up at a local clinic. Read More

Pan Afr Med J 2018 23;30:233. Epub 2018 Jul 23.

Service d'Urologie B, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc.

Emphysematous pyelonephritis is a necrotic infection of the kidney characterized by the presence of gas within the renal parenchyma, the secretory cavities or the perirenal spaces. It is a severe condition that could be life-threatening. Patient's management remains controversial and is based either on surgery or on medical treatment. Read More

Postgrad Med J 2018 12 20;94(1118):714-715. Epub 2018 Dec 20.

Department of Diabetes, Metabolic Diseases and Endocrinology, Fortis CDOC Hospital, New Delhi, India.

Intensive Care Med 2019 04 6;45(4):525. Epub 2018 Dec 6.

AIIMS, Rishikesh, Rishikesh, India.

J Nephrol 2018 12 5:161. Epub 2018 Dec 5.