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Emphysematous Pyelonephritis: Patient Characteristics and Management Approach

Introduction: Emphysematous pyelonephritis (EPN) is an acute, severe, necrotizing infection of the renal parenchyma and perirenal tissue that requires immediate treatment. However, the ideal approach to its management remains controversial. We conducted this study to determine the appropriate treatment modalities. Materials and Methods: A retrospective review of EPN cases revealed 10 consecutive cases from July 2003 to June 2012. Clinical and demographic data were collected from each patient. Results: All patients had diabetes mellitus, 5 presented with urinary tract obstruction by urolithiasis. Seven patients had type I disease and 3 had type II disease. Six of the type I patients underwent emergent nephrectomy and 1 of these died, the remaining patient refused surgical intervention and died after receiving medical management only. The type II patients underwent percutaneous drainage, and 2 of them subsequently underwent elective nephrectomy; all 3 survived. Conclusion: Our results suggest that emergency nephrectomy may be considered the initial management for type I EPN, while percutaneous drainage may be an effective initial treatment option for type II EPN.