RADIOLOGICAL MANAGEMENT OF EMPHYSEMATOUS PYELONEPHRITIS: A REPORT OF 3 CASE

Medecine

Emphysematous pyelonephritis is a necrotic kidney infection characterized by the presence of gas within the renal parenchyma, the excretory cavities, or the peri-renal spaces. Objective : Our main objective is to evaluate the various epidemiological, diagnostic, and evolutionary aspects of emphysematous pyelonephritis (EPN), as well as the role of conservative treatment, highlighting the importance of CT scans in the management of this condition in the urology department at Amitié Hospital in Nouakchott, Mauritania. Material and methods : This was a retrospective and descriptive study focusing on emphysematous pyelonephritis cases recorded from the hospital admission registers of Amitié Hospital in Nouakchott. The study period was 2 years (2016 to 2017). For each case, we collected epidemiological, clinical, biological, radiological, therapeutic, and evolutionary data. Results : We collected three medical records related to cases of emphysematous pyelonephritis, representing an incidence of 1.5 cases per year in the urology department. The average age of the patients was 51.6 years (with extremes ranging from 46 to 60 years). The medical history was primarily characterized by the presence of diabetes, which was found in all patients. The most common reason for consultation was febrile low back pain with a general deterioration in health. Biologically, the complete blood count revealed leukocytosis in only one patient, while the other two had normal white blood cell counts. Microcytic hypochromic anemia was observed in two patients. Additionally, C-reactive protein (CRP) levels were above 12 mg/L in all patients. Hyperglycemia was noted in all cases, with extreme values up to 4 g/L. Urine testing using a reactive strip identified diabetic ketoacidosis in one patient, while the urine cytobacteriological examination was only performed in one patient, which returned positive. The non-contrast urinary tract imaging (AUSP) showed gas densities in the renal area in one case, while for the others, AUSP was not performed. Ultrasound, performed on all patients, revealed gas bubbles in all cases. The diagnosis was confirmed by a CT scan in all patients. Treatment consisted of draining the purulent and gas collections through percutaneous drainage under CT guidance for all patients. Conclusion : In a diabetic patient, any pyelonephritis resistant to antibiotics should raise suspicion of emphysematous pyelonephritis, warranting a CT scan to confirm the diagnosis and guide treatment. Medical treatment alone can be effective, especially in cases that are detected early.

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