A near-fatal case of emphysematous pyelonephritis: Embracing the new management ‘gold standard’ – Saving the life while saving the kidney!

Abstract

Introduction: Emphysematous pyelonephritis (EPN) is a rare, acute, severe infection of the renal parenchyma and its surrounding tissues and is associated with a significant morbidity and mortality. Underlying diabetes is the most commonly associated risk factor.

Observation: We report on the presence of EPN (Grade 3a) in a patient with poorly controlled diabetes, who presented in septic shock due to EPN. Although previous older treatment algorithms would proceed with an immediate nephrectomy, based on her grade, she was successfully managed by incorporating the new treatment ‘gold standard’: medical management with percutaneous drainage. A high index of suspicion is required to detect and manage this life-threatening condition associated with diabetes, since the presenting symptoms may be non-specific. The diagnosis, risk factors, and current management options of EPN are expanded further.

Keywords: Diabetes; Emphysematous pyelonephritis (EPN); Percutaneous drainage; Nephrectomy; Septic shock