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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2021  |  Volume : 32  |  Issue : 1  |  Page : 286-288
Recurrent Emphysematous Pyelonephritis: Report of a Patient with Three episodes


Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

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Date of Web Publication16-Jun-2021
 

How to cite this article:
Sravani M, Subha A, Manuel MB, Alekhya B, Ram R, Kumar VS. Recurrent Emphysematous Pyelonephritis: Report of a Patient with Three episodes. Saudi J Kidney Dis Transpl 2021;32:286-8

How to cite this URL:
Sravani M, Subha A, Manuel MB, Alekhya B, Ram R, Kumar VS. Recurrent Emphysematous Pyelonephritis: Report of a Patient with Three episodes. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2021 Nov 30];32:286-8. Available from: https://www.sjkdt.org/text.asp?2021/32/1/286/318545


To the Editor,

We report a 46-year-lady, type 2 diabetic and hypertensive for the past six years. She presented with three episodes of emphysematous pyelonephritis (EPN). [Table 1] shows the data of the three episodes. [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5] show computed tomography images of our patient showing evidence of EPN in kidneys and urinary bladder.{Figure 1],
Figure 2: Air foci noted in urinary bladder suggestive of emphysematous cystitis.

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,
Figure 3: Computed tomography coronal image showing air foci in the collecting system of right kidney and in urinary bladder. Features suggestive of emphysematous pyelonephritis and cystitis.

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,
Figure 4: Computed tomography axial images showing contracted left kidney, air foci in the collecting system of right kidney suggestive of emphysematous pyelonephritis.

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,
Figure 5: Air foci noted in the urinary bl adder features cystitis.

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Table 1: Data of the three episodes of emphysematous pyelonephritis.

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Our patient dialysis in the second and third episodes. She was treated with the culture-specific antibiotics. The patient returned to the baseline serum creatinine and was withdrawn from dialysis.

There are several reports in the literature about EPN. Huang and Tseng reported a 51-year-female patient.[1] She was a diabetic, had EPN first in the right kidney, for which nephrectomy was done, and later EPN of left kidney for which ureteral stent was performed. In both, the episodes urine culture had shown growth of Escherichia coli. Unfortunately, patient could not be saved in the second episode.[2]

In a report by Wan et al, they described two distinct types of EPN according to the radiological findings. Since the mortality rate for type I EPN (69%) was higher than that for type II (18%), they stressed the fact that the differentiation is important due to the prognostic difference.[3] A study from India by Fatima et al reported an overall survival rate of 86.3%, denoting that the outcome in these patients has improved remarkably compared to perilous results of yesteryears (19/22).[4]

Conflict of interest: None declared.

Informed consent: Informed consent was obtained from the patient included in the study.



 
   References Top

1.
Huang JJ, Tseng CC. Emphysematous pyelonephritis: Clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000;160:797-805.  Back to cited text no. 1
    
2.
Huang JJ, Chen KW, Ruaan MK, Tsai HM. Recurrent emphysematous pyelonephritis. A case report. Int Urol Nephrol 1994;26:389-93.  Back to cited text no. 2
    
3.
Wan YL, Lee TU, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: Correlation between imaging findings and clinical outcome. Radiology 1996;198:433-8.  Back to cited text no. 3
    
4.
Fatima R, Jha R, Muthukrishnan J, et al. Emphysematous pyelonephritis: A single center study. Indian J Nephrol 2013;23:119-24.  Back to cited text no. 4
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Correspondence Address:
Rapur Ram
Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India
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DOI: 10.4103/1319-2442.318545

PMID: 34145152

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]



 

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