A Case Series of Emphysematous PyelonephritisReport as inadecuate




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Case Reports in Medicine - Volume 2014 2014, Article ID 587926, 6 pages -

Case Report

Department of Medicine, Sinai-Grace Hospital, Detroit Medical Center-Wayne State School of Medicine, 4th Floor, 6071 West Outer Drive, Detroit, MI 48235, USA

Department of Emergency Medicine, Detroit Receiving Hospital-Detroit Medical Center, 4201 Street Antoine, Suite 3R, Detroit, MI 48201, USA

Received 17 January 2014; Revised 15 March 2014; Accepted 15 March 2014; Published 9 April 2014

Academic Editor: Florian Thalhammer

Copyright © 2014 Camelia Arsene et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Emphysematous pyelonephritis EPN is an uncommon infection characterized by gas in the renal parenchyma and surrounding tissues. It is rapidly progressive, requiring appropriate therapy to salvage the infected kidney. Case Description. The case series presents 5 patients with a clinical and radiologic diagnosis of EPN. Each patient had a unique predisposing factor for developing EPN. Early goal directed therapy with intravenous fluids and antibiotics was given. This was followed by less invasive urologic interventions in an attempt to avoid nephrectomy and thereby salvage the infected kidney. All five patients were discharged in clinically stable conditions. Discussion and Conclusion. This case series provides added practice based support to available literature for managing EPN. Early goal directed medical therapy for sepsis coupled with interventional urologic procedures is a valuable alternative to circumvent an upfront emergent nephrectomy, except in cases where a fulminant infection may be present at the time of admission or develop later on in the course of the patients illness despite conservative line of therapy. It also highlights the importance of considering a diagnosis of EPN in patients with urinary infections, who have certain common predisposing factors listed in our case series.





Author: Camelia Arsene, Abhijit Saste, Shankar Arul, Janee Mestrovich, Revark Kammo, Mohammed Elbashir, and Gregory Berger

Source: https://www.hindawi.com/



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