https://doi.org/10.4081/ecj.2021.9847
A case of hematuria and vomiting in the emergency room: Never forget the emphysematous pyelonephritis
Submitted: 11 May 2021
Accepted: 16 August 2021
Published: 21 September 2021
Accepted: 16 August 2021
Abstract Views: 655
PDF: 272
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
We describe the case of a 68-year-old man with a known history of hypertension and diabetes mellitus presented to our Emergency Department, complaining of hematuria and vomiting in the last 12 hours, stypsis and urinary incontinence in the last week, and worsening hyporexia in the last 6 months. Bedside ultrasound documented a slight right pleural effusion with B lines in the middle and basal right field, gastrectasis, dilated fluid-filled bowel loops, potential signs of gas in the upper right quadrant, grade 3 bilateral hydronephrosis, and bladder globe. Abdominal CT scan confirmed the bilateral hydroureteronephrosis and showed the right kidney with Emphysematous Pyelonephritis (EPN) with extension into the perinephric and muscular planes for 24 cm, and initial EPN in the left kidney. A RT-PCR nasopharyngeal swab for SARS CoV-2 was negative. A diagnosis of ileum paretic, acute renal failure and urosepsis due to EPN was made.
Pontin AR, Barnes RD, Joffe J, Kahn D. Emphysematous pyelonephritis in diabetic patients. Br J Urol 1995;75:71–4.
DOI: https://doi.org/10.1111/j.1464-410X.1995.tb07237.x
Tang HJ, Li CM, Yen MY et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect 2001;34:125–30.
Song Y, Shen X. Diabetic ketoacidosis complicated by emphysematous pyelonephritis: a case report and literature review. BMC Urol 2020;20:6.
DOI: https://doi.org/10.1186/s12894-020-0575-0
Shokeir AA, El-Azab M, Mohsen T, El-Diasty T. Emphysematous pyelonephritis: a 15-year experience with 20 cases. Urology 1997;49:343–6.
DOI: https://doi.org/10.1016/S0090-4295(96)00501-8
Zhang Y, Zang GQ, Tang ZH, Yu YS. Emphysematous pyelonephritis. Rev Inst Med Trop Sao Paulo 2015;57:368.
DOI: https://doi.org/10.1590/S0036-46652015000400019
Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000;160:797-805.
DOI: https://doi.org/10.1001/archinte.160.6.797
Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU Int 2011;107:1474-8.
DOI: https://doi.org/10.1111/j.1464-410X.2010.09660.x
Liao HW, Chen TH, Lin KH et al. Emphysematous pyelonephritis caused by Bacteroides fragilis. Nephrol Dial Transplant 2005;20:2575–7.
DOI: https://doi.org/10.1093/ndt/gfi146
Christensen J, Bistrup C. Case report: emphysematous pyelonephritis caused by clostridium septicum and complicated by a mycotic aneurysm. Br J Radiol 1993;66:842–3.
DOI: https://doi.org/10.1259/0007-1285-66-789-842
Hildebrand TS, Nibbe L, Frei U, Schindler R. Bilateral emphysematous pyelonephritis caused by Candida infection. Am J Kidney Dis 1999;33:E10.
DOI: https://doi.org/10.1016/S0272-6386(99)70331-8
Kelly HA, MacCallum WG. Pneumaturia. J Am Med Assoc 1898;31:375–81.
DOI: https://doi.org/10.1001/jama.1898.92450080001001
Mallet M, Knockaert DC, Oyen RH, Van Poppel HP. Emphysematous pyelonephritis: no longer a surgical disease? Eur J Emerg Med 2002;9:266–9.
DOI: https://doi.org/10.1097/00063110-200209000-00012
Tseng CC, Wu JJ, Wang MC, et al. Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Am J Kidney Dis 2005;46:432–9.
DOI: https://doi.org/10.1053/j.ajkd.2005.05.019
Evanoff GV, Thompson CS, Foley R, Weinman EJ. Spectrum of gas within the kidney. emphysematous pyelonephritis and emphysematous pyelitis. Am J Med 1987;83:149–54.
DOI: https://doi.org/10.1016/0002-9343(87)90511-0
Yao J, Gutierrez OM, Reiser J. Emphysematous pyelonephritis. Kidney Int 2007;71:462-5.
DOI: https://doi.org/10.1038/sj.ki.5002001
Sama S, Chandra N. Unusual presentation of emphysematous pyelonephritis. Intensive Care Med 2019;45:525.
DOI: https://doi.org/10.1007/s00134-018-5491-3
Hirose Y, Kaida H. Emphysematous Pyelonephritis. N Engl J Med 2016;375:1671.
DOI: https://doi.org/10.1056/NEJMicm1501812
Wang YC, Wang JM, Chow YC, et al. Pneumomediastinum and subcutaneous emphysema as the manifestation of emphysematous pyelonephritis. Int J Urol 2004;11:909–11.
DOI: https://doi.org/10.1111/j.1442-2042.2004.00919.x
Bhatt B, Bhavsar B, Senanayke S, et al. Bilateral emphysematous pyelonephritis with multiple septic emboli to brain, lungs, and liver as an initial presentation of new-onset diabetes mellitus. NY Med J 2006
Kangjam SM, Irom KS, Khumallambam IS, Sinam RS. Role of conservative management in emphysematous pyelonephritis - A retrospective study. J Clin Diagn Res 2015;9:PC09-11.
DOI: https://doi.org/10.7860/JCDR/2015/16763.6795
Narlawar RS, Raut AA, Nagar A, et al. Imaging features and guided drainage in emphysematous pyelonephritis: A study of 11 cases. Clin Radiol 2004;59:192–7.
DOI: https://doi.org/10.1016/S0009-9260(03)00295-2
Chen CY, Chen CJ. Images in clinical medicine. Emphysematous pyelonephritis. N Engl J Med 2014;371:e34.
DOI: https://doi.org/10.1056/NEJMicm1314314
Chan PH, Kho VK, Lai SK, et al. Treatment of emphysematous pyelonephritis with broad-spectrum antibacterials and percutaneous renal drainage: an analysis of 10 patients. J Chin Med Assoc 2005;68:29–32.
DOI: https://doi.org/10.1016/S1726-4901(09)70128-5
Mydlo JH, Maybee GJ, Ali-Khan MM. Percutaneous drainage and/or nephrectomy in the treatment of emphysematous pyelonephritis. Urol Int 2003;70:147–50.
DOI: https://doi.org/10.1159/000068776
Somani BK, Nabi G, Thorpe P, et al. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol 2008;179:1844-9.
DOI: https://doi.org/10.1016/j.juro.2008.01.019
Deoraj S, Zakharious F, Nasim A, Missouris C. Emphysematous pyelonephritis: outcomes of conservative management and literature review. BMJ Case Rep. 2018;2018:bcr2018225931.
DOI: https://doi.org/10.1136/bcr-2018-225931
Karthikeyan VS, Manohar CMS, Mallya A, et al. Clinical profile and successful outcomes of conservative and minimally invasive treatment of emphysematous pyelonephritis. Cent European J Urol 2018;71:228-33.
Boakes E, Batura D. Deriving a management algorithm for emphysematous pyelonephritis: can we rely on minimally invasive strategies or should we be opting for earlier nephrectomy? Int Urol Nephrol 2017;49:2127–36.
DOI: https://doi.org/10.1007/s11255-017-1706-8
How to Cite
Poggiali, E., Tansini, F. ., Christodoulakis, K., Giovini, M., Magnacavallo, A., & Vercelli, A. (2021). A case of hematuria and vomiting in the emergency room: Never forget the emphysematous pyelonephritis. Emergency Care Journal, 17(3). https://doi.org/10.4081/ecj.2021.9847
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