Emphysematous pyelonephritis
Emphysematous pyelonephritis
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DOI：
10.1111/j.1464-410x.2010.09660.x
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发表时间：
2011-05-01
影响因子：
4.5
通讯作者：
Fordham, Mark
中科院分区：
文献类型：
--
作者：
Ubee, Sarvpreet Singh;McGlynn, Laura;Fordham, Mark
肺气肿性肾盂肾炎（EPN）是一种急性严重的肾实质及其周围组织坏死性感染，导致肾实质、收集系统或肾周组织中存在气体。EPN的死亡原因主要是由于脓毒性并发症。高达95%的EPN患者有潜在的未控制的糖尿病。继发于尿路梗阻的EPN的风险约为25-40%。根据影像学表现，EPN可分为三种类型。急性肾功能衰竭、显微或宏观血尿、严重蛋白尿是EPN的其他阳性表现。大肠杆菌是最常见的致病菌，在近70%的报告病例中从尿液或脓培养物中分离出该菌。x线平片显示肾床异常气体影，引起怀疑，而超声扫描或计算机断层扫描（CT）将证实肾内气体的存在，从而支持EPN的诊断。气体可能超出炎症部位延伸到囊下、肾周和肾旁间隙。在某些情况下，发现气体延伸到阴囊和精索。随后的案例研究表明，在医疗管理之外使用PCD可以成功治疗患者，并显著降低了死亡率。PCD应在有局部气体和肾功能组织存在的患者中进行。治疗策略包括单纯MM、PCD + MM、MM +急诊肾切除术、PCD + MM +急诊肾切除术。在一小部分患有MM和PCD的患者中，将需要随后的肾切除术，在这些患者中，报道的死亡率为6.6%，EPN患者的肾切除术可以是简单的，根治性的或腹腔镜的。
Emphysematous pyelonephritis (EPN) is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. The cause for mortality in EPN is primarily due to septic complications. Up to 95% of the cases with EPN have underlying uncontrolled diabetes mellitus. The risk of developing EPN secondary to a urinary tract obstruction is about 25-40%. There are three classifications of EPN based on radiological findings. Acute renal failure, microscopic or macroscopic haematuria, severe proteinuria are other positive findings in EPN. Escherichia coli is the most common causative pathogen with the organism isolated on urine or pus cultures in nearly 70% of the reported cases.A plain radiograph shows an abnormal gas shadow in the renal bed raising the suspicion whereas an ultrasound scan or computed tomography (CT) will confirm the presence of intra-renal gas thus supporting the diagnosis of EPN. Gas may extend beyond the site of inflammation to the sub capsular, perinephric and pararenal spaces. In some cases, gas was found to be extending into the scrotal sac and spermatic cord.Subsequent case studies have shown patients being successfully treated with PCD when used in addition to medical management, with significant reduction in the morality rates. PCD should be performed on patients who have localized areas of gas and functioning renal tissue is present. The treatment strategies include MM alone, PCD plus MM, MM plus emergency nephrectomy, and PCD plus MM plus emergency nephrectomy. In small proportion of patients managed with MM and PCD, subsequent nephrectomy will be required and in these patients the reported mortality is 6.6% Nephrectomy in patients with EPN can be simple, radical or laparoscopic.