SUCCESSFUL CONSERVATIVE MANAGEMENT OF EMPHYSEMATOUS PYELONEPHRITIS, BILATERAL OR IN A SOLITARY KIDNEY

Emphysematous pyelonephritis, bilateral or in a solitary kidney, is a life-threatening condition that requires prompt diagnosis and early in tervention. Reported mortality is high, despite desperate surgical mea sures often ending in loss of renal unit, but medical management, poss ibly combined with percutaneous drainage, is sometimes successful. We report two cases of emphysematous pyelonephritis, one bilateral and on e in a solitary kidney, with successful conservative management. Predi sposing factors were insulin-dependent diabetes mellitus and micronodu lar cirrhosis secondary to chronic alcoholism. Prompt sonographic diag nosis determined the success of conservative management. Escherichia c oli was identified as causal factor. In the bilateral case the clinica l picture improved within 48 h after control of diabetes and broad-spe ctrum antibiotic treatment. For the affected solitary kidney, percutan eous drainage and ureteric catheterization were required.