Emphysematous pyelonephritis: epidemiology, modern approaches to diagnosis and treatment

Abstract

Introduction. Emphysematous pyelonephritis (EPN) is a rare form of acute suppurative pyelonephritis, which is characterized by a rapid and severe course due to the pathogenic effect of the gas-forming bacterial flora. Currently, only a few hundred clinical cases of EPN are described in the literature. Currently, there are no standards for the surgical treatment of patients with EPN, but there is a clear tendency towards a wider use of minimally invasive methods of treatment and limitation of indications for nephrectomy. A risk-based approach based on the proposed radiological classifications of EPN is considered preferable. Purpose. Тo study all literature sources available for the current period on the Internet, describing clinical cases and experience in treating patients with a diagnosis of emphysematous pyelonephritis. Materials and methods. Тhe results of a search in the scientific databases PubMed, MEDLINE, Embase, elibrary were analyzed for the queries «emphysematous pyelonephritis», «classification», «gassing bacterial flora», «diabetes mellitus», «conservative treatment», «nephrectomy», «percutaneous drainage». 754 scientific publications were found, 25 were selected for detailed analysis. Results and discussion. Today, there are no standards for surgical treatment of patients with EP, but there is a clear trend towards wider use of minimally invasive methods of treatment and limiting the indications for nephrectomy. Minimally invasive methods of treating EN allows organ-preserving treatment and reduces the risk of renal failure. The lack of clear indications for the choice of the scope of surgical treatment and the low orientation of specialists towards radiological diagnostic criteria are the main reasons for excessive organ-carrying treatment of patients with PF. A risk-mediated approach based on the proposed clinical and radiological classifications of EP is considered preferable. In controversial cases, it is possible to recommend an attempt at minimally invasive treatment in combination with adequate conservative therapy, and only if it is ineffective, resort to performing nephrectomy. Conclusion. Indications for nephrectomy should be strictly limited and revised taking into account modern approaches. Nephrectomy should be an option of choice only if conservative treatment is impossible or ineffective.