Ultrasound,contrast-enhanced ultrasound and pyelonephritis:A narrative review

Acute pyelonephritis(APN)is a bacterial infection resulting in kidney inflammation,typically arising as a complication of an ascending urinary tract infection that ascends from the bladder to the kidneys.Clinical diagnosis is generally based on clinical and laboratory findings.Recent guidelines recommend not performing diagnostic imaging unless a complicated APN is suspected or the infection affects high-risk patients such as the elderly,immunocompromised individuals,or diabetics.Contrast-enhanced ultrasound(CEUS)is a valuable tool in both the diagnosis and follow-up of APN.It aids in distinguishing small simple nephritic involvement from abscess complications and monitoring their evolution over time during antibiotic therapy.Given its lack of ionizing radiation and nephrotoxicity,CEUS is a valid diagnostic modality for approaching and monitoring pyelonephritis,improving early identification and characterization of inflammatory lesions.This review aims to summarize the main evidence on the use of ultrasound and CEUS in the diagnosis of APN and its follow-up.

Matrix Metalloproteinase-2,Matrix Metalloproteinase-9,and Transforming Growth Factor Beta 1 Levels in Escherichia coli-Infected Rats with Acute Pyelonephritis

Objective:To investigate the expression of matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9),and transforming growth factor beta 1(TGF beta 1)in the kidney tissue of rats with pyelonephritis and their relationship with pyelonephritis by establishing a rat model of acute pyelonephritis.Methods:80 male Wistar rats were randomly divided into a control group and an experimental group,with 40 rats each.The rats of the control group were injected with and saline and those of the experimental group were injected with 10μg/mL Escherichia coli(E.coli)and saline(1:100);the solutions for both groups were administered every 3 days for 7 days.The expressions of MMP-2,MMP-9 and TGF beta 1 in the kidney tissues of rats in each group were observed.Results:The expression of MMP-9 and TGF beta 1in the kidney tissue of rat acute pyelonephritis model rats was significantly higher than those of the control group(P<0.01);the MMP-9 mRNA content in the kidney tissue of the experimental group was significantly higher than that of the control group(P<0.05);the TGF beta 1 mRNA content in the renal tissue of the experimental group increased significantly compared to the(P<0.05);MMP-2,MMP-9 and TGF beta 1 began to express in the early stage of pyelonephritis until the complete formation of renal pelvic edema.The difference between groups was statistically significant(P<0.01).Conclusion:MMP-9 and TGF beta 1 are important factors regulating renal tubular epithelial cell injury and inflammatory response.

Primary renal mucosa-associated lymphoid tissue lymphoma, the result of chronic pyelonephritis?

Objective: To report 2 cases of primary renal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma), and observe the relations between this rare tumor of kidney and chronic pyelonephritis. Methods: 2 renal MALT lymphomas were collected from referral consultation. Detailed clinical information were reviewed, morphological analysis based on the HE section, and immunohistochemistry were performed by CD20, CD79a, CD5, CD10, CD43, CD23, BCL10 and Cyclin D1 antibodies. Results: 2 female patients with age of 48 and 55, respectively, all had a history of chronic pyelonephritis. Under the B ultrasonic and CT scanning a bump in the kidney was found. Renal carcinoma suspected and hereby the whole nephrectomy performed. In the macroscopic, tumors were laid in the renal medulla, with dark red color and ill-defined boundary. In the microscopic, there were mixed lymphoid cells infiltrate which mainly consisted of small lympho- cytes, centrocyte-like cells, lymphoplasmacytoid and plasma cells, reactive follicles and lymphoepithelial lesions also could be seen in the lesion, but follicles colonization was rare. In fact, except changes of lymphoma, basic renal disease also could be seen. Most glomeruli were atrophic, some glomeruli were hyperplastic and hypertrophic. Tubules were dilated or contacted, many dilated tubules contained pink-color glassy-appearing casts that suggest the appearance of thyroid tissue. As a result, those 2 cases showed juxtaposed changes of lymphoma and pyelonephritis. Immunohistochemistry showed that tumor cells were CD20 and CD79a positive, CD43 was weak positive, but CD5, CD10, CD23, BCL10 and Cyclin D1 were all negative. Conclusion: Primary renal MALT lymphoma was very rare disease. According to the clinical manifestation, it’s hard to differentiate from renal cell carcinoma. But the morphological features were consistent with the classic MALT lymphomas in other sites. Immunophenotypic profiles were helpful for diagnosis. Based on the truth that many MALT lymphomas in other sites were connected with chronic inflammations, we suppose that the renal MALT lymphoma may originate from chronic pyelonephritis.

Comparison of computed tomography findings between bacteremic and non-bacteremic acute pyelonephritis due to Escherichia coli

AIM:To identify computed tomography(CT)findings that are associated with the presence of bacteremia in patients with acute pyelonephritis(APN)due to Escherichia coli(E.coli).METHODS:The clinical data and contrast-enhanced CT findings of 128 patients who were diagnosed with APN due to E.coli and showed renal abnormality on contrast-enhanced CT between January 2003 and November 2013 were retrospectively reviewed.The patients were divided into two groups according to the presence of bacteremia:The bacteremia group and the non-bacteremia group.The abnormality on contrast-enhanced CT were categorized into 5 renal and 4 extrarenal CT findings and compared between the two groups using the χ~2 test and multivariate logistic regression.RESULTS:Among the 128 patients,34 patients(26.6%)were classified into the bacteremia group and 94 patients(73.4%)into the non-bacteremia group.There was no statistically significant difference in gender between the two groups(P = 0.09),but the age of thepatients in the bacteremia group was higher than that of the patients in the non-bacteremia group(P < 0.01).Compared to the non-bacteremia group,1 renal CT finding such as urothelial thickening and 3 extrarenal CT findings such as diffuse peritoneal thickening,cystitis and pulmonary congestion were more frequently observed in the bacteremia group with statistical significance.The logistic regression analysis revealed that CT findings,including urothelial thickening,diffuse peritoneal thickening,cystitis and pulmonary congestion were suggested as the predictive CT findings of bacteremic APN.CONCLUSION:On CT,urothelial thickening,diffuse peritoneal thickening,cystitis,and pulmonary congestion are more frequently observed in patients with bacteremic APN due to E.coli.

Epidemiological profile and management of acute pyelonephritis in the emergency department of a tertiary hospital: A retrospective observational study

Objective:To assess the clinical and microbiological characteristics as well as the risk factors of early readmission(<72 h)in acute pyelonephritis(APN)patients discharged from emergency department(ED).Methods:The medical records of patients discharged with a diagnosis of APN between January 1,2014 and December 31,2015 were reviewed.Epidemiological,clinical,ultrasound results,and laboratory characteristics were collected,and the risk factors of prompt readmission and non-prompt readmission were assessed.Results:A total of 423 APN patients were included.The mean age was(44.3±19.0)years.The bulk of the patients were women(79.9%),and 20%of cases had episodes previously.Urine cultures were requested in 77.5%of cases,with Escherichia coli being the most frequently isolated bacterium(80.1%).Resistance to one or more antibiotics was found in 68.1%of the bacteria.The most widely used antibiotics were beta-lactam with beta-lactamases inhibitor(46%),and aminoglycosides in 24.4%of cases.Altogether,73.5%of the patients received antibiotic treatment in the ED,and 46.8%of the patients were discharged.Furthermore,6.1%of the patients discharged from the ED had re-admission without associated risk factors.Conclusions:Given the high rate of resistance,it is important to know the profile of antibiotics in different areas.Likewise,the administration of antibiotics in the ED is useful in the prevention of early readmissions of APN(<72 h).

Analysis of Pyelonephritis-Associated Beta Hemolytic Streptococcus in Japan

Pyelonephritis is an inflammation of the kidney tissue, calyces, and renal pelvis. It is commonly caused by bacterial infection that has spread up the urinary tract. Common bacteria are Escherichia coli and Enterococcus faecalis. Beta hemolytic streptococci also cause pyelonephritis. Beta hemolytic streptococcus such as Streptococcus agalactiae, and S. dysgalactiae subsp. equisimilis, when grown on blood-agar, produce complete hemolysis around each colony, usually cause severe infections including many cases of cellulitis, pneumonia, meningitis and sepsis. However the analysis of pyelonephritis causing beta hemolytic streptococcus has seldom been investigated. In this study, we tried to clarify the relationship between beta hemolytic streptococcus and pyelonephritis patient in Japan. We investigated beta hemolytic streptococcus isolated from pyelonephritis patient at two tertiary care hospitals in the central region of Japan by analyzing the background and antimicrobial susceptibility of beta hemolytic streptococcus. We recovered total sixteen beta hemolytic streptococcus in nine years. In pyelonephritis patients, beta hemolytic streptococcus was isolated from 9 S. agalactiae and 7 S. dysgalactiae subsp. equisimilis, respectively. The numbers of streptococci from female patients were more than those from male patients. Bacteria were not isolated from under 30 year patients. All S. dysgalactiae subsp. equisimilis were isolated from 60-year-age patients. About one fifth of beta hemolytic streptococcus had erythromycin and minocycline-resistant ability. Four beta hemolytic streptococci that were all S. agalactiae, had levofloxacin-resistant ability. Only one S. agalactiae had trimethoprim-sulfamethoxazole-resistant ability. Ampicillin was effective against all beta hemolytic streptococci. In our results, beta hemolytic streptococcus caused pyelonephritis in aged people and the quarter of these bacteria had some antibiotics resistance.

Persistent fever during treatment of a pregnant woman with acute pyelonephritis

Acute pyelonephritis is a serious infection in pregnancy. It is presented with fever, shaking chills and flank pain. Intravenous hydration and antimicrobial therapy are sufficient in the treatment unless pyelonephritis is complicated. In case of fever persisting for more than 48 h despite appropriate antimicrobial treatment, a possible complication such as urinary tract obstruction, abscess or phlegmon should be considered. Here, we present an 18-year-old pregnant woman with acute pyelonephritis whose persistent fever returned to normal after double-J ureteral stent was placed even if she had no finding of such a complication.

What is the prognosis of emphysematous pyelonephritis associated with extended-spectrum beta-lactamases producing microorganisms?

Objective:To describe the microbiological characteristics in emphysematous pyelonephritis(EPN),demonstrate the frequency of extended-spectrum beta-lactamase(ESBL)microorganisms,and determine if these microorganisms are associated with the prognosis of patients with EPN.Methods:We conducted a retrospective study in patients with a diagnosis of EPN in a tertiary care hospital of the northeast region of Mexico during the period from January 2011 to January 2016.Clinical variables were analyzed to determine association with the presence of ESBL-producing microorganisms.Statistical significance was set with p<0.05.Results:A total of 63 patients were included;55(87.3%)of them were females,with a median age of 55(interquartile range:45-65)years.Conservative management was indicated in 38.1%;42.9%were treated with ureteral stent;12.7%with open or percutaneous drainage;15.8%with early nephrectomy;and 9.5%with delayed nephrectomy.Reported mortality was 13(20.6%)cases;23(36.5%)cases required admission to the intensive care unit.The most frequent microorganism isolated was Escherichia coli(n=34,53.9%).ESBL microorganisms were found in 31.7%of the population.No significant association of ESBL was found with admission to the intensive care unit,or with increased mortality.Conclusions:To our knowledge,this is the first study that evaluates ESBL microorganisms as a prognostic factor in EPN.Risk factors associated with a poor prognosis in patients with EPN have been described.The microbiological factors,specifically ESBL-producing bacteria,do not seem to influence in the prognosis of these patients.

Successful endoscopic surgery for emphysematous pyelonephritis in a non-diabetic patient with autosomal dominant polycystic kidney disease: A case report

BACKGROUND Emphysema pyelonephritis(EPN)is a very dangerous type of urinary tract infection.It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly,and it can easily lead to systemic infections and even sepsis.The incidence is extremely low,and it is prevalent in patients with diabetes.We here report a case of EPN in a non-diabetic patient with autosomal dominant polycystic kidney disease(ADPKD).We share the diagnosis and treatment procedure for this extremely rare condition to make this disease easier to identify and address early.CASE SUMMARY A 47-year-old woman presented to the emergency department of our hospital with a high fever and left back pain lasting 4 d.She had a history of autosomal dominant polycystic kidney and polycystic liver.She was diagnosed with left type I EPN and her vital signs deteriorated so quickly that she underwent an emergency operation in which a D-J tube was inserted into her left ureter on the second day after admission.Two months later,she underwent a second-stage flexible ureteroscopy and lithotripsy.Despite postoperative sepsis,she finally recovered after active symptomatic support treatment and effective anti-infective treatment.CONCLUSION Although EPN is more likely to occur in diabetic patients,for non-diabetic patients with ADPKD and upper urinary tract obstruction,the disease also causes rapid deterioration.Early and accurate diagnosis and timely removal of the obstruction by invasive means may be able to save the damaged kidney and the patient’s life.

Serratia fonticola and its role as a single pathogen causing emphysematous pyelonephritis in a non-diabetic patient:A case report

BACKGROUND Diagnosis of emphysematous pyelonephritis has been described around the world for some decades,frequently associated with Escherichia coli and other anaerobic,gas-forming bacteria and mostly in patients living with diabetes.We present a case report of emphysematous pyelonephritis in a non-diabetic patient caused by Serratia fonticola as well as a brief literature review to draw attention to this rare pathogen as a cause of pyelonephritis.CASE SUMMARY A 38-year-old female presented with fever,severe pain in the right flank and changes in urinary habits.She was admitted,and emphysematous pyelonephritis was confirmed by an abdominal computerized tomography and urine cultures;the latter showed Serratia fonticola as a single pathogen.After 3 d of being treated with piperacillin/tazobactam and percutaneous drainage she became afebrile,and the gas presence reduced.CONCLUSION Emphysematous pyelonephritis infections in non-diabetic patients are rare but can be severe and life-threatening.This case suggests that Serratia fonticola infection can occur in patients undergoing invasive or instrumented procedures.

Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review

BACKGROUND Emphysematous pyelonephritis(EPN)is a rare but fatal necrotic infection of the kidney,which usually leads to septic shock.Therefore,early diagnosis and optimized therapy are of paramount importance.In the past two decades,pointof-care ultrasound(POCUS)has been widely used in clinical practice,especially in emergency and critical care settings,and helps to rapidly identify the source of infection in sepsis.We report a rare case in which a“falls”sign on POCUS played a pivotal role in the early diagnosis of EPN.CASE SUMMARY A 57-year-old man presented with fever and lumbago for 3 d prior to admission.He went to the emergency room,and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts.This imaging feature was like a mini waterfall.His blood and urine culture demonstrated Escherichia coli bacteremia,and EPN associated with septic shock was diagnosed.The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed.He subsequently underwent computed tomography-guided percutaneous catheter drainage,and fully recovered.We also review the literature on the sonographic features of POCUS in EPN.CONCLUSION This case indicates that a“falls”sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.

Emphysematous pyelonephritis:Six case reports and review of literature

BACKGROUND Emphysematous pyelonephritis(EPN)is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma,collecting system,or perinephric tissue and has a poor prognosis.EPN occurs primarily in people with diabetes mellitus(DM),but can occur in those without DM when the associated renoureteral unit is obstructed.CASE SUMMARY We describe our experience with six patients who developed EPN.Five patients had DM,including one with diabetic ketoacidosis,one with multisystem involvements,including eye,lung and brain.Bilateral urolithiasis was present in one case,along with emphysematous cystitis.Unilateral kidney stones were present in one patient.One patient was an older man in poor general health.Five individuals survived and underwent surgical procedures including ureteral stent installation(Double J stent placement),percutaneous nephrostomy and perinephric abscess puncture drainage,while one died because the patient’s family chose to terminate therapy.Klebsiella pneumoniae and Escherichia coli were the microorganisms implicated.CONCLUSION We conclude that EPN is a potentially fatal illness.A positive outcome necessitates early detection.Therapeutic measures should be implemented as soon as a diagnosis is made.

Does delaying ureteral stent placement lead to higher rates of preoperative acute pyelonephritis during pregnancy?

BACKGROUND Pregnancy with renal colic may cause pyelonephritis,decreased renal function,systemic infection and even shock in pregnant women,and cause premature birth and other adverse pregnancy outcomes.When surgery is necessary,the relationship between timing of the operation and the outcome of the mother and child are not known.AIM To investigate the association between time to ureteral stent placement and clinical outcomes of patients with renal colic during pregnancy.METHODS In this retrospective study,pregnant women with renal colic who underwent surgery were studied.Maternal preoperative acute pyelonephritis(PANP),pregnancy outcome,and length of hospital stay(LOS)were compared between the two groups.RESULTS 100 patients were included in the analysis,median age was 30 years.Median time to ureteral stent placement was 48 h(interquartile range,25-96 h),and 32 patients(32%)were diagnosed with PANP.PANP was closely related to hospitalization costs,re-admission to the hospital due to urinary tract infection after surgery and premature delivery.Multivariate analysis found that stone location and time from pain to admission were related to PANP.CONCLUSION Both early and delayed surgery are safe and effective for the treatment of renal colic during pregnancy.Early surgery may be superior to a delayed procedure due to shorter LOS.For pregnant patients with renal colic,delayed surgery within 48 h is not related to the clinical outcome of the mother and child.However,the time from pain to hospital admission was related to PANP.

An alveolate kidney:A case report of emphysema pyelonephritis

Rationale:Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment.The disease is often misdiagnosed due to its diversity of clinical manifestations.Patient’s concern:A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea.Physical examination showed percussion pain on the right costovertebral angle.Besides,she had a history of diabetes mellitus and urinary calculus.Diagnosis:Emphysematous pyelonephritis.Intervention:The patient accepted antishock therapy,tight glucose control,and broad-spectrum anti-infective therapy.After stabilization of the general condition,an ultrasound-guided percutaneous nephrostomy was performed.Outcome:Her conditions became stable over the following days.She presented a favorable clinical course,with normalization of renal function and positive improvements in imaging findings in a month.Lessons:Early diagnosis and rapid medical management are the keys to successful treatment.CT is an important method for the diagnosis of emphysematous pyelonephritis.For patients with severe lesions,percutaneous renal drainage combined with active anti-infection should be given in time.

Emphysematous Pyelonephritis in a Renal Transplant Patient

Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection of the kidney that is caused by gas-forming organisms. We report a case of a 58-year-old man with a renal transplant who presented to the emergency room with nausea, vomiting and right lower quadrant abdominal pain. At the time of presentation, he was hemodynamically stable, and the abdominal examination was significant for tenderness over the allograft. Urinalysis was positive for large amounts of leukocyte esterase and white blood cells. He received empiric antibiotic coverage with piperacillin/tazobactam. Over the following 24 hours, the patient developed septic shock manifested by hemodynamic instability. A non-contrast CT scan of the abdomen and pelvis elucidated a heterogeneous gas containing collection in the allograft. Emergent transplant nephrectomy was performed. Postoperatively, the patient rapidly recovered and was subsequently discharged home to commence outpatient hemodialysis. A review of the literature suggests that early recognition of the severity of EPN as manifested by hemodynamic instability dictates emergent transplant nephrectomy as the treatment of choice.

Emphysematous Pyelonephritis with Renal Calculi Treated with Percutaneous Nephrolithotomy

Introduction: Percutaneous nephrolithotomy (PCNL) today has become the first line treatment for large renal stones. The infective complications of PCNL in patients with emphysematous pyelonephritis EPN would be higher and be responsible for the increased morbidity. We retrospectively reviewed our hospital records of patients with EPN and renal stones undergoing PCNL, and assessed the outcome especially in relation to infection. Materials & Methods: The case records of all patients with EPN and renal stones having undergone PCNL at our centre were retrospectively reviewed and analyzed. The age, gender, presenting symptoms, features of septicemia, preoperative drainage, post-operative complications and outcome were recorded. Results: During the study period, 12 patients (eight females and four males) with a mean age of years who were diagnosed to have EPN, underwent PCNL for extraction of renal calculi. All patients were initially managed conservatively;five patients underwent cystoscopy and Double J stent insertion on the affected side and seven patients underwent PCN insertion. Six weeks later, PCNL was performed (Urine culture was negative) undercover of appropriate antibiotics and general anaesthesia. Nine patients had Class II;two patients had class IIIb and one patient had class IV complications as classified by Clavien-Dindo. All patients recovered well and post-operative x-rays showed clearance of stone in all. Conclusions: Percutaneous nephrolithotomy is a safe, viable option in patients with emphysematous pyelonephritis and renal calculi follows a period of conservative treatment and effective drainage of the pelvicalyceal system by either a ureteric stent or percutaneous nephrostomy. The calculi can be effectively managed with endoscopic measures with renal preservation and a good functional outcome.

Xanthogranulomatous Pyelonephritis Associated with Crohn’s Disease and Primary Hyperparathyroidism

We report on a case of unilateral and diffuse xanthogranulomatous pyelonephritis (XGP) associated with Crohn’s disease and primary hyperparathyroidism (HPT). The patient had undiagnosed primary HPT for at least a year prior to presentation. The co-existence of Crohn’s disease and primary HPT caused calcium oxalate stone likely by the known mechanism of hypercalcemia and hyperoxaluria respectively. The patient developed XGP, a rare disease, as a result of infected calcium oxalate stone which was treated with antibiotics and unilateral nephrectomy. To the best of our knowledge, this is the first case of XGP associated with Crohn’s disease and primary HPT.

Antibiotics for complicated urinary tract infection and acute pyelonephritis: A systematic review

BACKGROUND The increasing rates of antibiotic-resistance in the recent years has caused the emergence of multiple drug-resistant bacteria.Therefore,antibiotics that are recommended by the current clinical guidelines may not be effective for the treatment of complicated urinary tract infection(UTI)and acute pyelonephritis.AIM To determine the clinical efficacy and safety of antibiotics for the treatment of complicated urinary tract infection and acute pyelonephritis.METHODS A search of three medical databases(PubMed,EMBASE and Google Scholar)were conducted for eligible articles describing the use of antibiotics in managing complicated UTI and acute pyelonephritis.The following keywords were used to perform the literature search:“urinary tract infection”,“complicated UTI”,“pyelonephritis”,“treatment”and“antibiotics”.Additional articles of interest were retrieved from the reference list of selected papers.Eligibility criteria for this systematic review were diagnosis of either complicated urinary tract infection or acute pyelonephritis and the use of antibiotics in management.Clinical trials and observational studies were included in this review while case reports and reviews were excluded.The methodological quality of clinical trials and observational studies was assessed.A descriptive approach was adopted to analyze the data due to the variation of methodology and interventions.RESULTS A total of 183 studies were screened;eight studies that matched all the eligibility criteria were included in this review.The antibiotics included in this systematic review were ceftazidime-avibactam,doripenem,levofloxacin,meropenemvaborbactam,piperacillin-tazobactam,plazomicin,tazobactam-ceftolozane and gentamicin.Two clinical trials reported that shorter duration of levofloxacin or non-fluoroquinolone antibiotics treatment was as effective as the duration of antibiotic therapy recommended by the current guidelines in treating complicated UTI and pyelonephritis.Besides that,ceftazidime-avibactam,piperacillintazobactam and tazobactam-ceftolozane can be used as an alternative to carbapenem in treating extended-spectrumβ-lactamase-producing Escherichia coli.In the included studies,the cure rates of the complicated UTI and pyelonephritis by meropenem-vaborbactam,piperacillin-tazobactam and tazobactam-ceftolozane was comparable at between 95.6%and 98.4%.Furthermore,the clinical trials showed that levofloxacin had a relatively high rate of adverse events(33.1%and 47.7%in two clinical trials)while tazobactamceftolozane had a relatively low rate of adverse events(17.5%).All studies have limitations and a potential for bias.CONCLUSION The use of novel antibiotics and combination antibiotic therapy can be considered in treating complicated UTI and acute pyelonephritis when resistance to recommended antibiotics occurs.

Emphysematous Pyelonephritis in a Black African Woman Managed with Antibiotics Alone

Introduction: Emphysematous pyelonephritis (EPN) is a severe, life-threatening infection of the renal parenchyma. This condition is characterized by the production of intrarenal and perinephric gas. In the world, the EPN is currently limited to case series reported. No cases have been described in black Africa. Aims: Related a first case of EPN diagnosed and treated in the University Hospital Center Sylvanus Olympio of Lomé in Togo. Observation: A 40 years old woman, with antecedent of diabetes presented pyelonephritis emphysematous class 2. She was treated successfully with antibiotic alone without using percutaneous drainage or nephrectomy. Conclusion: As reported in every case series, it was a young diabetic patient with a clinical features of acute pyelonephritis which CT scan had helped lay the EPN class 2 diagnosed. The germ was Klebsiella pneumoniae. She was treated with adapted antibiotic alone.

A novel mortality risk score for emphysematous pyelonephritis:A multicenter study of the Global Research in the Emphysematous Pyelonephritis group

Background:Emphysematous pyelonephritis(EPN)is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality.We aimed to formulate a score that classifies the risk of mortality in patients with EPN at hospital admission.Materials and methods:Patients diagnosed with EPN between 2013 and 2020 were retrospectively included.Data from 15 centers(70%)were used to develop the scoring system,and data from 7 centers(30%)were used to validate it.Univariable and mułtivariable logistic regression analyses were performed to identify independent factors related to mortality.Receiver operating characteristic curve analysis was performed to construct the sconng system and calculate the risk of mortality.A standardized regression coefficient was used to quantify the discriminating power of each factor to convert the individual coefficients into points.The area under the curve was used to quantify the scoring system performance.An 8-point scoring system for the mortality risk was created(range,0-7).Results:In total,570 patients were included(400 in the test group and 170 in the validation group).Independent predictors of mortality in the multivariable logistic regression were included in the scoring system:quick Sepsis-related Organ Failure Assessment score≥2(2 points),anemia,paranephric gas extension,leukocyte count>22,000/pL,thrombocytopenia,and hyperglycemia(1 point each).The mortality rate was<5%for scores≤3,83.3%for scores 6,and 100%for scores 7.The area under the Curve was 0.90(95%confidence interval,0.84-0.95)for test and 0.91(95%confidence interval,0.84-0.97)for the validation group.Condusions:Our score predicts the risk of mortality in patients with EPN at presentation and may help clinicians identify patients at a higher risk of death.