Emphysematous Pyelonephritis

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Abstract
EMPHYSEMATOUS pyelonephritis (EPN) has been defined as a necrotizing infection of the renal parenchyma and its surrounding areas that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue.1-7 Emphysematous pyelonephritis occurs almost exclusively in patients with diabetes mellitus (DM), but occasionally in patients without DM along with obstruction of the corresponding renoureteral unit.1,8-10 It deserves special attention because of its life-threatening potential and has been generally regarded as a rare renal infection. However, with the more extensive use of abdominal ultrasound (echography) and computed tomography (CT scan) in the evaluation of patients with symptoms and signs of sepsis or complicated urinary tract infection (UTI), more cases of EPN are being recognized and these cases are being reported in the urology and radiology journals,1-22 and less frequently in internal medicine or nephrology journals.23-31 We believe that EPN is not rare and should be considered an important clinical entity. Nevertheless, no large clinical experience of EPN concerned with management and prognostic factors has been reported from a single institution. The mechanism of gas formation and pathogenesis of EPN are also unclear.