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Original Articles
Analysis of Treatment Modalities of 24 Cases with Emphysematous Pyelonephritis
Phil Hyun Song, and Hyun Tae Kim
Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
Vol.43 Num.4 (p339~342)
Background: Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of renal parenchyma with high mortality and its adequate treatment modality remains controversial. There have been only a limited number of studies about EPN, particularly in Korea. Therefore, we present our experience in patients with EPN.

Materials and Methods: Twenty-four patients that were diagnosed with EPN between January 1999 and June 2010 at a single medical center were retrospectively evaluated. Patient characteristics, causative pathogens, clinical features, complications, and mortality rates as modalities of managements and radiological classes of EPN were analyzed.

Results: All of the 24 patients selected for the study were diabetic. Twentyone patients were positive at urine culture and Escherichia coli (85.7%) was the predominant pathogen identified. Of the 24 patients, 17 were managed by broadspectrum antibiotics and percutaneous renal drainage, whereas 7 were managed by direct nephrectomy. The total mortality rates were 12.5%, regardless of the modalities of management. The mortality rates were 12.5% in Class 3A and 40% in Class 3B, according to computed tomography (CT) findings.

Conclusions: Although conservative treatment included antibiotics, and percutaneous renal drainage offered an effective therapy for EPN, nephrectomy should be considered in patients with Class 3 EPN.
Keywords : Pyelonephritis, Percutaneous, Drainage