In a large epn (classes 3 and 4), 17 (85%) ...

Emphysematous pyelonephritis

(EPN) is a rare, severe aerogenic infection renal parenchyma and surrounding areas. Classification of radiological and adequate therapeutic treatment is controversial and prognostic factors and pathogenesis remain unclear. To clarify the clinical features, radiological classification and prognostic factors of EPN, compare control conditions (eg, antibiotics only chreskozhnoho catheter drainage combined with antibiotics or kidney) and the results among different classes of EPN and radiological aerogenic clarify the mechanism and pathogenesis of EPN analysis gases and lasix heart failure abnormal results. Forty-eight EPN cases from our institution were enrolled between August 1.1989, and November 30, 1997. According to the results of radiological CT scan, they are divided into the following classes: (1) Class 1: gas collection system only (2) Class 2: gas in the renal parenchyma without extension ekstrarenalnyh space (3) class 3A: extension gas or abscess to pararenal space; class 3B: extension of gas or abscess in prynyrkovyy space, and (4) 4th Grade: bilateral EPN or a single kidney with EPN. Clinical manifestations, management and outcome were compared. Summary of gas samples from 6 patients. Pathological of 8 patients who received kidneys were examined. Statistical methods consisted of Fisher exact criterion (2 tailed) for categorical variables and rank sum test Vilkoksona for continuous variables to test predictors of adverse prognosis. Forty-six patients (96%) had diabetes, and 10 (22%) of 46 as obstruction of urinary tract in the corresponding renoureteral device. 2 other patients without diabetes (4%) had severe hydronephrosis. Twenty-one (72%) of 29 patients with diabetes and glycosylated hemoglobin (1c) level above 0. 08. E. coli (69%) and Klebsiella pneumonia (29%) are the most common pathogens. The mortality rate in patients who received antibiotic treatment only 40% (2 of 5 patients). The success of chreskozhnoho catheter for drainage (PCD) in combination with antibiotics was 66% (27 of 41 patients). In grades 1 and 2 EPN, all patients who were treated with PCD or ureteral catheter in combination with antibiotics survived. In a large EPN (classes 3 and 4), 17 (85%) of 20 patients with less than 2 risk factors (eg, thrombocytopenia, acute renal function impairment of consciousness or shock) were successfully treated with PCB in combination with antibiotic treatment, and patients with 2 or more risk factors had significantly higher failure rate than those who do not or only 1 risk factor (92% versus 15%, P. 001). Eight of 14 patients who had failed treatment with PCD have been following kidney, 7 of whom survived. Only 2 patients are operated by direct kidneys and survived. The overall success rate was 90% of kidneys (9 of 10 patients). Overall mortality was 18. 8% (9 of 48 patients). Five of six samples of gas contained hydrogen (average, 12. 8%), and everything was carbon dioxide (an average of 14. 4%). Abnormal results of 8 out of 10 who underwent nephrectomy revealed poor perfusion in most cases (eg, heart attack, in 5 patients, vascular thrombosis in 3 patients and atherosclerosis and / or glomerulosclerosis, 4 patients). Acute renal infection E coli or K pneumonia in patients with diabetes and / or urinary tract obstruction is the cornerstone for the development of EPN. Mixed fermentation of glucose by Enterobacteriaceae is the main gas. For localized EPN (classes 1 and 2), PCD combined with antibiotics can provide good results. (ABSTRACT truncated).