emphysematous pyelonephritis

Etiology

• diabetes mellitus is the most important risk factor
• pathogens
  • E coli (most common)
  • Proteus
  • Klebsiella
  • anaerobic Streptococci
  • Candida

Pathology

• renal emphysema (gas & pus in the renal parenchyma)

Management

• antibiotic treatment to cover gram-negative organisms
  • cephalosporin or fluoroquinolone
  • piperacillin tazobactam (Zosyn) or carbapenem if high risk of resistant organism
• percutaneous drainage of gas & pus
  • relieves urinary obstruction
• nephrectomy may be needed if percutaneous drainage unsuccessful

More general terms

• pyelonephritis