Emphysematous Pyelonephritis – Complicated UTIs

00:01 We're now coming to emphysematous pyelonephritis.

00:04 This is really a fulminant necrotizing life-threatening form of acute pyelonephritis.

00:10 Its associated with diabetes mellitus.

00:12 And it may cause urinary obstruction.

00:15 We see this with gas forming microorganisms like E. coli, Klebsiella, pseudomonas aeruginosa and proteus.

00:22 The symptoms are similar to acute pyelonephritis.

00:25 In terms of the diagnosis of emphysematous pyelonephritis, a urine analysis is going to be critical we'll see pyuria on the presence of white cells in our urine and you'll also see a positive urine culture.

00:37 We also want to obtain a CT of the abdomen pelvis.

00:41 Here y ou can see this is an axial cut through a CT scan involving the kidneys and if you look at that right kidney where the arrow is pointing, that's hypodensity or that darkness is actually gas caused by those microorganisms.

00:55 So you've got an enlarged kidney and you actually have gas that's being formed in that kidney.

01:00 The treatment is urgent broad-spectrum parenteral antibiotics.

01:05 We also often times we'll get our interventional radiology colleagues or our Urology colleagues for percutaneous drainage of that gas forming area in the kidney in order to relieve the obstruction.

01:17 If the above steps fail, then oftentimes our Urology colleagues are coming in and doing a nephrectomy or taking out the kidney in order to cure this particular disease.