Emphysematous pyelonephritis

Background

• Rare gas-forming infection nearly always occurring in pts w/ DM and obstruction
  • Pts appear toxic and septic; nephrectomy may be required

Clinical Features

• fever
• abdominal or flank pain
  • crepitus over the flank may be present in severe cases
• nausea/vomiting
• dyspnea
• acute kidney injury
• altered mental status
• shock
• thrombocytopenia

Differential Diagnosis

Dysuria

• Genitourinary infection
  • Acute cystitis ("UTI")
  • Pyelonephritis
  • Urethritis
  • Chronic cystitis
  • Infected nephrolithiasis
  • Prostatitis
  • Epididymitis
  • Renal abscess/perinephric abscess
  • Emphysematous pyelonephritis
• Nephrolithiasis
• Urethral issue
  • Urethritis
  • Urolithiasis
  • Urethral foreign body
  • Urethral diverticulum
  • Allergic reaction (contact dermatitis)
  • Chemical irritation
  • Urethral stricture or obstruction
  • Trauma to vagina, urethra, or bladder
• Gynecologic
  • Vaginitis/cervicitis
  • PID
  • Genital herpes
  • Pelvic organ prolapse
  • Fistula
  • Cystocele
• Other
  • Diverticulitis
  • Interstitial cystitis
  • Behavioral symptom without detectable pathology

Workup

Labs

• CBC with high WBC, low platelets
• UA with urine culture
• Creatinine
• Blood culture

Imaging

• CT is definitive