Ver el código de «Emphysematous pyelonephritis»

==Background==
[[File:Blausen 0592 KidneyAnatomy 01.png|thumb|Renal anatomy.]]
*Rare gas-forming infection nearly always occurring in patients with [[DM]] and obstruction
**Patients appear toxic and [[septic]]; nephrectomy may be required

{{UTI types}}

==Clinical Features<ref> Tang HJ, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001 Jun. 34(2):125-30. </ref>==
*[[Fever]]
*[[Abdominal pain]] or [[Flank pain]]
**crepitus over the flank may be present in severe cases
*[[Nausea/vomiting]]
*[[Dyspnea]]
*[[AKI|Renal dysfunction]]
*[[Altered mental status]]
*[[Shock]]
*[[Thrombocytopenia]]

==Differential Diagnosis==
{{Dysuria DDX}}

==Evaluation==
[[File:PMC4421217 sfn002fig2.png|thumb|Axial CT scan image of left kidney reveals emphysematous pyelonephritis.]]
===Labs===
*CBC with [[leukocytosis|high WBC]], [[thrombocytopenia|low platelets]]
*[[Urinalysis]] with urine culture
*Creatinine
*Blood culture

===Imaging===
*CT is definitive
*Staging<ref>Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000 Mar 27. 160(6):797-805.</ref>:
**Class 1 - gas confined to collecting system
**Class 2 - gas confined to renal parenchyma alone
**Class 3A - perinephric extension of gas or abscess
**Class 3B - extension of gas beyond Gerota fascia
**Class 4 - bilateral or EPN in solitary kidney

==Management==
*[[IVF]]
*Antibiotics
**IV [[ampicillin]], [[gentamicin]], [[metronidazole]]
**[[Vancomycin]] in place of [[ampicillin]] for penicillin allergy

==Disposition<ref>Shetty S et al. Emphysematous Pyelonephritis Treatment & Management. eMedicine. Apr 11, 2014. http://emedicine.medscape.com/article/457306-treatment#showall.</ref>==
*Poor prognostic risk factors:
**Creatinine > 1.4mg/dL
**Platelets < 60k
**Altered mental status
**Shock
*Urological consult for percutaneous drainage, stent placement, or nephrectomy (classes 3 and 4 with 2 or more prognostic risk factors)
*Presence of obstructive stone requires even more urgent surgical intervention
*Mortality rates between ~20-40%

==See Also==

==External Links==

==References==
<references/>

[[Category:Renal]]
[[Category:Urology]]
[[Category:ID]]