Management of Emphysematous Renal Tract Infections

Emphysematous infections of the renal tract encompass a spectrum of life‐threatening conditions in which gas‐forming pathogens invade the urinary system. The most recognised form, emphysematous pyelonephritis, arises predominantly in patients with poorly controlled diabetes and is characterised by necrosis of renal parenchyma and perirenal tissues. A multimodal management strategy is required, combining prompt fluid resuscitation, glycaemic control and broad‐spectrum antimicrobial therapy targeted to common causative organisms such as Escherichia coli and Klebsiella pneumoniae. Cross‐sectional imaging, chiefly computed tomography, underpins early diagnosis, risk stratification and selection of intervention. Minimally invasive techniques—principally percutaneous drainage of gas and purulent collections—have largely supplanted immediate nephrectomy in stable patients, enabling renal preservation. Nevertheless, surgical nephrectomy remains indispensable when conservative measures fail or infection is fulminant. Emerging prognostic scoring systems facilitate early identification of patients likely to require intensive care support. Less common manifestations, including emphysematous cystitis and fungal variants of renal tract infection, demand similar principles of rapid diagnosis and tailored therapy. Globally, the rising burden of diabetes renders these gas‐forming infections an increasing challenge for healthcare systems.

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Management of Emphysematous Renal Tract Infections publication trend

The graph below shows the total number of articles in management of emphysematous renal tract infections across all publications each year (not limited to Nature Index journals).

Technical terms

Emphysematous pyelonephritis (EPN): A fulminant, necrotising infection of the kidney characterised by intraparenchymal gas formation.

Percutaneous drainage: A minimally invasive, image‐guided procedure to evacuate gas and infected fluid collections.

Nephrectomy: Surgical excision of a kidney, reserved for cases unresponsive to conservative and percutaneous management.

Sepsis: A life‐threatening organ dysfunction resulting from a dysregulated host response to infection.

Hypoalbuminaemia: A reduced serum albumin concentration, reflecting systemic illness and associated with poorer prognoses.

References

1. Predictors of failure of conservative treatment among patients with emphysematous pyelonephritis. BMC Infectious Diseases (2014).
2. Predicting need for intensive care unit admission in adult emphysematous pyelonephritis patients at emergency departments: comparison of five scoring systems. Scientific Reports (2019).
3. Acute bilateral emphysematous pyelonephritis successfully managed by medical therapy alone: A case report and review of the literature. BMC Nephrology (2002).
4. Emphysematous cystitis: mortality, risk factors, and pathogens of a rare disease. Clinics and Practice (2017).
5. Complicated bilateral fungal emphysematous pyelonephritis in a 55-year-old diabetic female: A case report and review of literature. Current Medical Mycology (2018).