Emphysematous Pyelonephritis

During a 15 - year peroid, 6 patients diagnosed as emphysematous pyelonephritis were studied. There were 5 females and one male. Age ranged from 38 to 67 years old. Left side was predominate with a ratio 5 : 1 to right side. All patients had poorly controlled diabetis melletus. Two had renal insufficiency at presentation and one had history of renal failure that recovered after stone removal. Fever with abdominal pain was the chief presenting symptoms of all patients. Two had jaundice, 3 had upper abdominal mass and one had associated gross hematuria.    All were admitted at department of internal medicine before urologic consultation. Diagnosis of emphysematous pyelonephritis was made by plain film KUB in all patients although an ultrasound of abdomen had been done in everyone but failed to diagnose this condition . Nephrectomy was done in 3 patients, nephrolithotomy in one and one had only opened drainage. Urine culture was done in 3 patients with all negative result. Hemoculture yeilded 2 positive from 3 and all pus culture from renal content showed bacterial growth. E.coli was found in 3 and Klebsiella pneumoniae in 2 patients. Most organism was the same as pus or hemoculture except one that hemoculture was E.coli while pus culture had Pseudomonas aeruginosa growth instead. No patient died in this series