PubMed HealthSearch

PubMed · 2000679

Bilateral emphysematous pyelonephritis.

Abstract

Emphysematous pyelonephritis is an uncommon and serious infection associated with gas-forming coliform bacteria. Bilateral involvement is rare with only 10 reported cases in the English literature. Prompt and aggressive management is required to salvage these patients. Preservation of renal function using broad-spectrum antibiotics and surgical drainage provide the greatest benefit to these patients. Three new cases are presented with a brief review of the results of management in the reported cases.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

B A Lowe, M D Poage. 1991. Bilateral emphysematous pyelonephritis.. https://doi.org/10.1016/0090-4295(91)80290-n

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

[Vaginitis emphysematosa].

Vaginitis emphysematosa is a benign, uncommon condition characterised by the presence of gas-filled cysts beneath the vaginal epithelium. Cases has been reported in pregnant women, in patients with diseases of the cardiovascular system and in patients with Trichomonas or Gardnerella vaginitis. To date the etiology and pathogenesis have not been fully elucidated. A case of vaginitis emphysematosa in a patient with cardiovascular disease is described.

Emphysema

Adverse effects of neutrophils on the lung.

Studies of both emphysema and adult respiratory distress syndrome (ARDS) support the premise that lung injury is due to unregulated host defense mechanisms. A major mediator of host defense and injury is the neutrophil, which is relatively incapable of regulating its own function. Accordingly, defects in regulatory mechanisms allow neutrophils to damage the lungs. Emphysema serves as a prime example of this link between host defense and injury. Hereditary emphysema is caused by a deficiency in alpha 1-antitrypsin (alpha 1-AT), a protease inhibitor. The decreased levels of this enzyme in affected individuals result in inadequate protection against neutrophil elastase and other proteolytic enzymes, leading to lung damage. Patients with acquired emphysema, associated with cigarette smoking, have normal levels of alpha 1-AT in their lungs. However, the alpha 1-AT in these patients has a reduced ability to associate with and inhibit the action of neutrophil elastase. Thus, both types of emphysema involve an alteration in the balance between proteases and antiproteases. The lung damage observed in patients with ARDS also appears to involve neutrophils, but in this case elastase may not be the culprit. In these patients, neutrophil elastase appears to be inactivated by high levels of alpha 1-AT, thus preventing excess protease action. It is hoped that a more complete understanding of the mechanisms involved in host defense and injury will enable the development of specific therapeutic interventions, such as the alpha 1-AT replacement therapy that is being used to treat patients with hereditary emphysema.

Emphysema

[Emphysematous pyelonephritis].

A case of emphysematous pyelonephritis (EPN) is described. EPN is a severe suppurative infection of the renal parenchyma and the perirenal tissue, characterized by intra-renal, and possibly perirenal, gas formation. This is a rare form of acute pyelonephritis. The condition is associated with a high mortality. Diabetic patients are particularly prone to the disease. The diagnosis is established with great certainty by computed tomography of the kidneys. The condition should be treated with an intensive combined medical-urological regimen with percutaneous nephrostomy guided by computed tomography or ultrasound should be performed. If no therapeutic response occurs, surgical incision and drainage or nephrectomy are recommended. In the present case of EPN, the medical treatment proved adequate.

Emphysema