Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a...Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a sig-nificant concern,necessitating early diagnosis,severity assessment,and timely intervention to improve outcomes.This study proposes a modified National Early Warning Score 2(mNEWS 2)to enhance risk stratification and predictive accuracy in EPN management.The mNEWS 2 refines the original NEWS 2 system,which aggregates 6 physiological indicators(body temperature,systolic blood pressure,pulse rate,oxygen saturation,breathing rate,and degree of consciousness),by incorporating weighted risk stratification indices and specific cutoff values derived from clinical observations,statistical modeling,and predictive per-formance analysis.A pilot study identified optimal thresholds,with a score of 15 maximizing predictive performance for mortality risk and intervention needs,validated through receiver operating characteristic curve analysis.So,the mNEWS 2 score represents a significant advancement in EPN management,offering improved risk stratification and treatment outcomes.展开更多
BACKGROUND Diagnosis of emphysematous pyelonephritis has been described around the world for some decades,frequently associated with Escherichia coli and other anaerobic,gas-forming bacteria and mostly in patients liv...BACKGROUND Diagnosis of emphysematous pyelonephritis has been described around the world for some decades,frequently associated with Escherichia coli and other anaerobic,gas-forming bacteria and mostly in patients living with diabetes.We present a case report of emphysematous pyelonephritis in a non-diabetic patient caused by Serratia fonticola as well as a brief literature review to draw attention to this rare pathogen as a cause of pyelonephritis.CASE SUMMARY A 38-year-old female presented with fever,severe pain in the right flank and changes in urinary habits.She was admitted,and emphysematous pyelonephritis was confirmed by an abdominal computerized tomography and urine cultures;the latter showed Serratia fonticola as a single pathogen.After 3 d of being treated with piperacillin/tazobactam and percutaneous drainage she became afebrile,and the gas presence reduced.CONCLUSION Emphysematous pyelonephritis infections in non-diabetic patients are rare but can be severe and life-threatening.This case suggests that Serratia fonticola infection can occur in patients undergoing invasive or instrumented procedures.展开更多
BACKGROUND Emphysematous pyelonephritis(EPN)is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma,collecting system,or perineph...BACKGROUND Emphysematous pyelonephritis(EPN)is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma,collecting system,or perinephric tissue and has a poor prognosis.EPN occurs primarily in people with diabetes mellitus(DM),but can occur in those without DM when the associated renoureteral unit is obstructed.CASE SUMMARY We describe our experience with six patients who developed EPN.Five patients had DM,including one with diabetic ketoacidosis,one with multisystem involvements,including eye,lung and brain.Bilateral urolithiasis was present in one case,along with emphysematous cystitis.Unilateral kidney stones were present in one patient.One patient was an older man in poor general health.Five individuals survived and underwent surgical procedures including ureteral stent installation(Double J stent placement),percutaneous nephrostomy and perinephric abscess puncture drainage,while one died because the patient’s family chose to terminate therapy.Klebsiella pneumoniae and Escherichia coli were the microorganisms implicated.CONCLUSION We conclude that EPN is a potentially fatal illness.A positive outcome necessitates early detection.Therapeutic measures should be implemented as soon as a diagnosis is made.展开更多
Objective:To describe the microbiological characteristics in emphysematous pyelonephritis(EPN),demonstrate the frequency of extended-spectrum beta-lactamase(ESBL)microorganisms,and determine if these microorganisms ar...Objective:To describe the microbiological characteristics in emphysematous pyelonephritis(EPN),demonstrate the frequency of extended-spectrum beta-lactamase(ESBL)microorganisms,and determine if these microorganisms are associated with the prognosis of patients with EPN.Methods:We conducted a retrospective study in patients with a diagnosis of EPN in a tertiary care hospital of the northeast region of Mexico during the period from January 2011 to January 2016.Clinical variables were analyzed to determine association with the presence of ESBL-producing microorganisms.Statistical significance was set with p<0.05.Results:A total of 63 patients were included;55(87.3%)of them were females,with a median age of 55(interquartile range:45-65)years.Conservative management was indicated in 38.1%;42.9%were treated with ureteral stent;12.7%with open or percutaneous drainage;15.8%with early nephrectomy;and 9.5%with delayed nephrectomy.Reported mortality was 13(20.6%)cases;23(36.5%)cases required admission to the intensive care unit.The most frequent microorganism isolated was Escherichia coli(n=34,53.9%).ESBL microorganisms were found in 31.7%of the population.No significant association of ESBL was found with admission to the intensive care unit,or with increased mortality.Conclusions:To our knowledge,this is the first study that evaluates ESBL microorganisms as a prognostic factor in EPN.Risk factors associated with a poor prognosis in patients with EPN have been described.The microbiological factors,specifically ESBL-producing bacteria,do not seem to influence in the prognosis of these patients.展开更多
BACKGROUND Emphysematous pyelonephritis(EPN)is a rare but fatal necrotic infection of the kidney,which usually leads to septic shock.Therefore,early diagnosis and optimized therapy are of paramount importance.In the p...BACKGROUND Emphysematous pyelonephritis(EPN)is a rare but fatal necrotic infection of the kidney,which usually leads to septic shock.Therefore,early diagnosis and optimized therapy are of paramount importance.In the past two decades,pointof-care ultrasound(POCUS)has been widely used in clinical practice,especially in emergency and critical care settings,and helps to rapidly identify the source of infection in sepsis.We report a rare case in which a“falls”sign on POCUS played a pivotal role in the early diagnosis of EPN.CASE SUMMARY A 57-year-old man presented with fever and lumbago for 3 d prior to admission.He went to the emergency room,and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts.This imaging feature was like a mini waterfall.His blood and urine culture demonstrated Escherichia coli bacteremia,and EPN associated with septic shock was diagnosed.The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed.He subsequently underwent computed tomography-guided percutaneous catheter drainage,and fully recovered.We also review the literature on the sonographic features of POCUS in EPN.CONCLUSION This case indicates that a“falls”sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.展开更多
BACKGROUND Emphysema pyelonephritis(EPN)is a very dangerous type of urinary tract infection.It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly,and it can easily lead to systemic...BACKGROUND Emphysema pyelonephritis(EPN)is a very dangerous type of urinary tract infection.It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly,and it can easily lead to systemic infections and even sepsis.The incidence is extremely low,and it is prevalent in patients with diabetes.We here report a case of EPN in a non-diabetic patient with autosomal dominant polycystic kidney disease(ADPKD).We share the diagnosis and treatment procedure for this extremely rare condition to make this disease easier to identify and address early.CASE SUMMARY A 47-year-old woman presented to the emergency department of our hospital with a high fever and left back pain lasting 4 d.She had a history of autosomal dominant polycystic kidney and polycystic liver.She was diagnosed with left type I EPN and her vital signs deteriorated so quickly that she underwent an emergency operation in which a D-J tube was inserted into her left ureter on the second day after admission.Two months later,she underwent a second-stage flexible ureteroscopy and lithotripsy.Despite postoperative sepsis,she finally recovered after active symptomatic support treatment and effective anti-infective treatment.CONCLUSION Although EPN is more likely to occur in diabetic patients,for non-diabetic patients with ADPKD and upper urinary tract obstruction,the disease also causes rapid deterioration.Early and accurate diagnosis and timely removal of the obstruction by invasive means may be able to save the damaged kidney and the patient’s life.展开更多
Introduction: Emphysematous pyelonephritis (EPN) is a severe, life-threatening infection of the renal parenchyma. This condition is characterized by the production of intrarenal and perinephric gas. In the world, the ...Introduction: Emphysematous pyelonephritis (EPN) is a severe, life-threatening infection of the renal parenchyma. This condition is characterized by the production of intrarenal and perinephric gas. In the world, the EPN is currently limited to case series reported. No cases have been described in black Africa. Aims: Related a first case of EPN diagnosed and treated in the University Hospital Center Sylvanus Olympio of Lomé in Togo. Observation: A 40 years old woman, with antecedent of diabetes presented pyelonephritis emphysematous class 2. She was treated successfully with antibiotic alone without using percutaneous drainage or nephrectomy. Conclusion: As reported in every case series, it was a young diabetic patient with a clinical features of acute pyelonephritis which CT scan had helped lay the EPN class 2 diagnosed. The germ was Klebsiella pneumoniae. She was treated with adapted antibiotic alone.展开更多
Background:Management of renal calculi in the presence of emphysematous pyelonephritis(EPN)is challenging.The optimal management strategy for patients with EPN and renal calculi remains unclear.This study aimed to eva...Background:Management of renal calculi in the presence of emphysematous pyelonephritis(EPN)is challenging.The optimal management strategy for patients with EPN and renal calculi remains unclear.This study aimed to evaluate the safety and efficacy of percutaneous nephrolithotomy(PCNL)in the management of these patients and to provide insights into the postoperative outcomes and complications of PCNL according to the modified Clavien-Dindo classification.Materials and methods:This retrospective study included patients with EPN and renal stones who underwent PCNL,after initial conservative management,between January 2012 and December 2021.Patient demographics,presenting symptoms,features of septicemia,preoperative drainage,postoperative complications,and outcomes were recorded.Postoperative complications were categorized according to the modified Clavien-Dindo classification.Results:A total of 48 patients with EPN and renal calculi were included in this study.Percutaneous nephrolithotomy was performed 4-6 weeks later after obtaining a negative urine culture or under appropriate antibiotic coverage if the culture was unsterile.Of the total,39(81.25%)patients had postoperative complications,but only 9(18.75%)patients had grade III or higher complications.Of these,3(6.25%)patients had grade IIIa complications,3(6.25%)had grade IIIb complications,2(4.1%)had grade IVa complications,and 1(2.08%)had grade IVb complications and was admitted to the intensive care.No mortality was observed during the postoperative period.Conclusions:Initial conservativemanagement of EPN followed by PCNL after initial infection control is an effective strategy for managing these patients.Patients with higher EPN grades have a higher risk ofmajor postoperative complications after PCNL for renal stones.Specifically,patients with an EPN class 3 or 4 had a higher risk of complications than those with an EPN class 2 or lower.Patients with EPN class 1 have a relatively uncomplicated postoperative course after PCNL.展开更多
Background:Emphysematous pyelonephritis(EPN)is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality.We aimed to formulate a score that classifies the risk of mortali...Background:Emphysematous pyelonephritis(EPN)is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality.We aimed to formulate a score that classifies the risk of mortality in patients with EPN at hospital admission.Materials and methods:Patients diagnosed with EPN between 2013 and 2020 were retrospectively included.Data from 15 centers(70%)were used to develop the scoring system,and data from 7 centers(30%)were used to validate it.Univariable and mułtivariable logistic regression analyses were performed to identify independent factors related to mortality.Receiver operating characteristic curve analysis was performed to construct the sconng system and calculate the risk of mortality.A standardized regression coefficient was used to quantify the discriminating power of each factor to convert the individual coefficients into points.The area under the curve was used to quantify the scoring system performance.An 8-point scoring system for the mortality risk was created(range,0-7).Results:In total,570 patients were included(400 in the test group and 170 in the validation group).Independent predictors of mortality in the multivariable logistic regression were included in the scoring system:quick Sepsis-related Organ Failure Assessment score≥2(2 points),anemia,paranephric gas extension,leukocyte count>22,000/pL,thrombocytopenia,and hyperglycemia(1 point each).The mortality rate was<5%for scores≤3,83.3%for scores 6,and 100%for scores 7.The area under the Curve was 0.90(95%confidence interval,0.84-0.95)for test and 0.91(95%confidence interval,0.84-0.97)for the validation group.Condusions:Our score predicts the risk of mortality in patients with EPN at presentation and may help clinicians identify patients at a higher risk of death.展开更多
Emphysematous pyelonephritis （EPN） is a rare infectious disease, of which risk factors are poorly controlled diabetes mellitus, immunosuppression, and urinary tract obstruction. In comparison with simple pyelonephri...Emphysematous pyelonephritis （EPN） is a rare infectious disease, of which risk factors are poorly controlled diabetes mellitus, immunosuppression, and urinary tract obstruction. In comparison with simple pyelonephritis, EPN is an acute severe necrotizing and gas-forming infection of the renal parenchyma with a mortality rate of up to 25%. Among the reported cases of EPN, there has only been one report of the disease where the ＂invisible kidney＂ was detected in the lung windows on noneontrast abdominal computed tomography （CT）. This rare case was treated with vacuum sealing drainage （VSD, Weigao Holding, China） and recovered quickly.展开更多
Rationale:Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment.The disease is often misdiagnosed due to its diversity of clinical manifestations.Patient’s ...Rationale:Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment.The disease is often misdiagnosed due to its diversity of clinical manifestations.Patient’s concern:A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea.Physical examination showed percussion pain on the right costovertebral angle.Besides,she had a history of diabetes mellitus and urinary calculus.Diagnosis:Emphysematous pyelonephritis.Intervention:The patient accepted antishock therapy,tight glucose control,and broad-spectrum anti-infective therapy.After stabilization of the general condition,an ultrasound-guided percutaneous nephrostomy was performed.Outcome:Her conditions became stable over the following days.She presented a favorable clinical course,with normalization of renal function and positive improvements in imaging findings in a month.Lessons:Early diagnosis and rapid medical management are the keys to successful treatment.CT is an important method for the diagnosis of emphysematous pyelonephritis.For patients with severe lesions,percutaneous renal drainage combined with active anti-infection should be given in time.展开更多
文摘Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a sig-nificant concern,necessitating early diagnosis,severity assessment,and timely intervention to improve outcomes.This study proposes a modified National Early Warning Score 2(mNEWS 2)to enhance risk stratification and predictive accuracy in EPN management.The mNEWS 2 refines the original NEWS 2 system,which aggregates 6 physiological indicators(body temperature,systolic blood pressure,pulse rate,oxygen saturation,breathing rate,and degree of consciousness),by incorporating weighted risk stratification indices and specific cutoff values derived from clinical observations,statistical modeling,and predictive per-formance analysis.A pilot study identified optimal thresholds,with a score of 15 maximizing predictive performance for mortality risk and intervention needs,validated through receiver operating characteristic curve analysis.So,the mNEWS 2 score represents a significant advancement in EPN management,offering improved risk stratification and treatment outcomes.
文摘BACKGROUND Diagnosis of emphysematous pyelonephritis has been described around the world for some decades,frequently associated with Escherichia coli and other anaerobic,gas-forming bacteria and mostly in patients living with diabetes.We present a case report of emphysematous pyelonephritis in a non-diabetic patient caused by Serratia fonticola as well as a brief literature review to draw attention to this rare pathogen as a cause of pyelonephritis.CASE SUMMARY A 38-year-old female presented with fever,severe pain in the right flank and changes in urinary habits.She was admitted,and emphysematous pyelonephritis was confirmed by an abdominal computerized tomography and urine cultures;the latter showed Serratia fonticola as a single pathogen.After 3 d of being treated with piperacillin/tazobactam and percutaneous drainage she became afebrile,and the gas presence reduced.CONCLUSION Emphysematous pyelonephritis infections in non-diabetic patients are rare but can be severe and life-threatening.This case suggests that Serratia fonticola infection can occur in patients undergoing invasive or instrumented procedures.
文摘BACKGROUND Emphysematous pyelonephritis(EPN)is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma,collecting system,or perinephric tissue and has a poor prognosis.EPN occurs primarily in people with diabetes mellitus(DM),but can occur in those without DM when the associated renoureteral unit is obstructed.CASE SUMMARY We describe our experience with six patients who developed EPN.Five patients had DM,including one with diabetic ketoacidosis,one with multisystem involvements,including eye,lung and brain.Bilateral urolithiasis was present in one case,along with emphysematous cystitis.Unilateral kidney stones were present in one patient.One patient was an older man in poor general health.Five individuals survived and underwent surgical procedures including ureteral stent installation(Double J stent placement),percutaneous nephrostomy and perinephric abscess puncture drainage,while one died because the patient’s family chose to terminate therapy.Klebsiella pneumoniae and Escherichia coli were the microorganisms implicated.CONCLUSION We conclude that EPN is a potentially fatal illness.A positive outcome necessitates early detection.Therapeutic measures should be implemented as soon as a diagnosis is made.
基金Support and Financial Disclosure:Own resources of the UrologyService,"Dr.Jose Eleuterio Gonzalez"University Hospital,Universidad Autonoma de Nuevo Leon(UR18-00008).
文摘Objective:To describe the microbiological characteristics in emphysematous pyelonephritis(EPN),demonstrate the frequency of extended-spectrum beta-lactamase(ESBL)microorganisms,and determine if these microorganisms are associated with the prognosis of patients with EPN.Methods:We conducted a retrospective study in patients with a diagnosis of EPN in a tertiary care hospital of the northeast region of Mexico during the period from January 2011 to January 2016.Clinical variables were analyzed to determine association with the presence of ESBL-producing microorganisms.Statistical significance was set with p<0.05.Results:A total of 63 patients were included;55(87.3%)of them were females,with a median age of 55(interquartile range:45-65)years.Conservative management was indicated in 38.1%;42.9%were treated with ureteral stent;12.7%with open or percutaneous drainage;15.8%with early nephrectomy;and 9.5%with delayed nephrectomy.Reported mortality was 13(20.6%)cases;23(36.5%)cases required admission to the intensive care unit.The most frequent microorganism isolated was Escherichia coli(n=34,53.9%).ESBL microorganisms were found in 31.7%of the population.No significant association of ESBL was found with admission to the intensive care unit,or with increased mortality.Conclusions:To our knowledge,this is the first study that evaluates ESBL microorganisms as a prognostic factor in EPN.Risk factors associated with a poor prognosis in patients with EPN have been described.The microbiological factors,specifically ESBL-producing bacteria,do not seem to influence in the prognosis of these patients.
基金Foundation of Health Commission of Guizhou Province,No.gzwjkj2020-1-021.
文摘BACKGROUND Emphysematous pyelonephritis(EPN)is a rare but fatal necrotic infection of the kidney,which usually leads to septic shock.Therefore,early diagnosis and optimized therapy are of paramount importance.In the past two decades,pointof-care ultrasound(POCUS)has been widely used in clinical practice,especially in emergency and critical care settings,and helps to rapidly identify the source of infection in sepsis.We report a rare case in which a“falls”sign on POCUS played a pivotal role in the early diagnosis of EPN.CASE SUMMARY A 57-year-old man presented with fever and lumbago for 3 d prior to admission.He went to the emergency room,and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts.This imaging feature was like a mini waterfall.His blood and urine culture demonstrated Escherichia coli bacteremia,and EPN associated with septic shock was diagnosed.The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed.He subsequently underwent computed tomography-guided percutaneous catheter drainage,and fully recovered.We also review the literature on the sonographic features of POCUS in EPN.CONCLUSION This case indicates that a“falls”sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.
文摘BACKGROUND Emphysema pyelonephritis(EPN)is a very dangerous type of urinary tract infection.It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly,and it can easily lead to systemic infections and even sepsis.The incidence is extremely low,and it is prevalent in patients with diabetes.We here report a case of EPN in a non-diabetic patient with autosomal dominant polycystic kidney disease(ADPKD).We share the diagnosis and treatment procedure for this extremely rare condition to make this disease easier to identify and address early.CASE SUMMARY A 47-year-old woman presented to the emergency department of our hospital with a high fever and left back pain lasting 4 d.She had a history of autosomal dominant polycystic kidney and polycystic liver.She was diagnosed with left type I EPN and her vital signs deteriorated so quickly that she underwent an emergency operation in which a D-J tube was inserted into her left ureter on the second day after admission.Two months later,she underwent a second-stage flexible ureteroscopy and lithotripsy.Despite postoperative sepsis,she finally recovered after active symptomatic support treatment and effective anti-infective treatment.CONCLUSION Although EPN is more likely to occur in diabetic patients,for non-diabetic patients with ADPKD and upper urinary tract obstruction,the disease also causes rapid deterioration.Early and accurate diagnosis and timely removal of the obstruction by invasive means may be able to save the damaged kidney and the patient’s life.
文摘Introduction: Emphysematous pyelonephritis (EPN) is a severe, life-threatening infection of the renal parenchyma. This condition is characterized by the production of intrarenal and perinephric gas. In the world, the EPN is currently limited to case series reported. No cases have been described in black Africa. Aims: Related a first case of EPN diagnosed and treated in the University Hospital Center Sylvanus Olympio of Lomé in Togo. Observation: A 40 years old woman, with antecedent of diabetes presented pyelonephritis emphysematous class 2. She was treated successfully with antibiotic alone without using percutaneous drainage or nephrectomy. Conclusion: As reported in every case series, it was a young diabetic patient with a clinical features of acute pyelonephritis which CT scan had helped lay the EPN class 2 diagnosed. The germ was Klebsiella pneumoniae. She was treated with adapted antibiotic alone.
文摘Background:Management of renal calculi in the presence of emphysematous pyelonephritis(EPN)is challenging.The optimal management strategy for patients with EPN and renal calculi remains unclear.This study aimed to evaluate the safety and efficacy of percutaneous nephrolithotomy(PCNL)in the management of these patients and to provide insights into the postoperative outcomes and complications of PCNL according to the modified Clavien-Dindo classification.Materials and methods:This retrospective study included patients with EPN and renal stones who underwent PCNL,after initial conservative management,between January 2012 and December 2021.Patient demographics,presenting symptoms,features of septicemia,preoperative drainage,postoperative complications,and outcomes were recorded.Postoperative complications were categorized according to the modified Clavien-Dindo classification.Results:A total of 48 patients with EPN and renal calculi were included in this study.Percutaneous nephrolithotomy was performed 4-6 weeks later after obtaining a negative urine culture or under appropriate antibiotic coverage if the culture was unsterile.Of the total,39(81.25%)patients had postoperative complications,but only 9(18.75%)patients had grade III or higher complications.Of these,3(6.25%)patients had grade IIIa complications,3(6.25%)had grade IIIb complications,2(4.1%)had grade IVa complications,and 1(2.08%)had grade IVb complications and was admitted to the intensive care.No mortality was observed during the postoperative period.Conclusions:Initial conservativemanagement of EPN followed by PCNL after initial infection control is an effective strategy for managing these patients.Patients with higher EPN grades have a higher risk ofmajor postoperative complications after PCNL for renal stones.Specifically,patients with an EPN class 3 or 4 had a higher risk of complications than those with an EPN class 2 or lower.Patients with EPN class 1 have a relatively uncomplicated postoperative course after PCNL.
文摘Background:Emphysematous pyelonephritis(EPN)is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality.We aimed to formulate a score that classifies the risk of mortality in patients with EPN at hospital admission.Materials and methods:Patients diagnosed with EPN between 2013 and 2020 were retrospectively included.Data from 15 centers(70%)were used to develop the scoring system,and data from 7 centers(30%)were used to validate it.Univariable and mułtivariable logistic regression analyses were performed to identify independent factors related to mortality.Receiver operating characteristic curve analysis was performed to construct the sconng system and calculate the risk of mortality.A standardized regression coefficient was used to quantify the discriminating power of each factor to convert the individual coefficients into points.The area under the curve was used to quantify the scoring system performance.An 8-point scoring system for the mortality risk was created(range,0-7).Results:In total,570 patients were included(400 in the test group and 170 in the validation group).Independent predictors of mortality in the multivariable logistic regression were included in the scoring system:quick Sepsis-related Organ Failure Assessment score≥2(2 points),anemia,paranephric gas extension,leukocyte count>22,000/pL,thrombocytopenia,and hyperglycemia(1 point each).The mortality rate was<5%for scores≤3,83.3%for scores 6,and 100%for scores 7.The area under the Curve was 0.90(95%confidence interval,0.84-0.95)for test and 0.91(95%confidence interval,0.84-0.97)for the validation group.Condusions:Our score predicts the risk of mortality in patients with EPN at presentation and may help clinicians identify patients at a higher risk of death.
文摘Emphysematous pyelonephritis （EPN） is a rare infectious disease, of which risk factors are poorly controlled diabetes mellitus, immunosuppression, and urinary tract obstruction. In comparison with simple pyelonephritis, EPN is an acute severe necrotizing and gas-forming infection of the renal parenchyma with a mortality rate of up to 25%. Among the reported cases of EPN, there has only been one report of the disease where the ＂invisible kidney＂ was detected in the lung windows on noneontrast abdominal computed tomography （CT）. This rare case was treated with vacuum sealing drainage （VSD, Weigao Holding, China） and recovered quickly.
文摘Rationale:Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment.The disease is often misdiagnosed due to its diversity of clinical manifestations.Patient’s concern:A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea.Physical examination showed percussion pain on the right costovertebral angle.Besides,she had a history of diabetes mellitus and urinary calculus.Diagnosis:Emphysematous pyelonephritis.Intervention:The patient accepted antishock therapy,tight glucose control,and broad-spectrum anti-infective therapy.After stabilization of the general condition,an ultrasound-guided percutaneous nephrostomy was performed.Outcome:Her conditions became stable over the following days.She presented a favorable clinical course,with normalization of renal function and positive improvements in imaging findings in a month.Lessons:Early diagnosis and rapid medical management are the keys to successful treatment.CT is an important method for the diagnosis of emphysematous pyelonephritis.For patients with severe lesions,percutaneous renal drainage combined with active anti-infection should be given in time.
