EMPHYSEMATOUS PYELONEPHRITIS - A 15-YEAR EXPERIENCE WITH 20 CASES

Objectives. To review our experience with emphysematous pyelonephritis over the past 15 years. Methods. Twenty patients with emphysematous p yelonephritis were reviewed regarding diagnosis, treatment, and outcom e. Results. Women outnumbered men (75% versus 25%), and 80% of patient s were diabetic. The left kidney was more frequently affected than the right one (60% versus 35%) and both kidneys were involved in 5%. Obst ruction of the corresponding renoureteral unit was found in all the no ndiabetic and in half of the diabetic patients. Diagnosis was confirme d by gas in the parenchyma or perinephric space by plain x-ray of the abdomen or computed tomography. Escherichia coli was the most common o rganism; it was found in 70% of urine cultures. A prompt attempt to co ntrol diabetes was made, and intravenous antibiotics were given. Nephr ectomy was immediately performed after stabilization of the general co ndition of the patients. A total of 80% of patients survived the proce dures. Conclusions. For successful management of emphysematous pyelone phritis, appropriate medical treatment should be attempted but immedia te nephrectomy should not be delayed. (C) 1997, Elsevier Science Inc.