Introduction
Emphysematous pyelonephritis (EPN) is a category of emphysematous UTI’s that may be defined as the necrotizing infection of renal parenchyma, associated with the formation of gas in the renal parenchyma, collecting system or perinephric tissue. Although the pathogenesis is poorly understood, diabetes mellitus and urinary tract obstruction are the major risk factors for EPN. EPN is associated with significant mortality with prompt management being critical. EPN associated with a staghorn calculus is rare, with only a handful of cases described in the literature.
Method/Description
A 69-year-old female presented to the emergency department with a 3-day history of severe stabbing right flank pain, associated with fevers (38.8), nausea and vomiting. Pertinent past medical history included a smoking history, poorly controlled type 2 diabetes mellitus, COPD, obstructive sleep apnoea, obesity. CT-imaging revealed a right perinephric abscess, emphysematous changes around the kidney and a right staghorn calculus. She was commenced on broad-spectrum antibiotics and a nephrostomy tube was inserted. She improved with antibiotics and percutaneous drainage. A DTPA renogram was performed which demonstrated a less than 15% functioning right kidney. She has been scheduled for a right radical nephrectomy.
Consclusions
Emphysematous pyelonephritis is an uncommon presentation but can be fatal if not treated promptly with intravenous antibiotics and percutaneous drainage. EPN associated with staghorn calculus is rare. Acute management appears to be similar to that of classical EPN with good outcomes. However, EPN associated with staghorn has poor outcomes and invariably leads to the surgical excision of the affected kidney.