ISSN: 1300-0292
İndekslendiği Dizinler: SCIENCE CITATION INDEX EXPANDED
CINAHL, Index Copernicus,
Chemical Abstracts (CA),
Excerpta Medica / EMBASE
Dil: Türkçe, İngilizce
İçerik: Orijinal Araştırma, Derleme, Editöre Mektup, Olgu Sunumu, Tıp Eğitimi, Tıbbi Kitap İncelemeleri
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Emphysematous Pyelonephritis: A Brief Review
Dr. Mustafa ALTAY,a Dr. Murat DURANAYa
aII. Dahiliye Kliniği, S.B. Ankara Eğitim ve Araştırma Hastanesi, ANKARA
Emphysematous pyelonephritis (EP) is a rarely seen, acute necrotising pyelonephritis. Usually it occurs in the middle-aged and elderly. About 90% of the patients are diabetics. Most of the nondiabetic patients present with urinary obstruction. Four factors are described for EP pathogenesis. These are the presence of gas-forming bacteria, high level of tissue glucose, impaired tissue perfusion, and a defective immune response.
The disease usually has a sudden beginning and poor prognosis. Following the initial symptoms, septicemia and acute renal failure develop in rapid succession. Laboratory tests are of limited benefit for the diagnosis. The pathogenic microorganism can be detected from blood and urine cultures, but the results are usually delayed. Abdominal CT is the most sensitive imaging method in exhibiting gas, in defining the localisation and limits of the affected area and in evaluating the extent of disease.
A recently accepted suggestion for management is to begin with wide spectrum antibiotics and to proceed with percutaneous drainage if necessary and, finally, to undergo elective nephrectomy if this approach proves ineffective . EP has a high mortality in spite of treatment. Thus, EP should be suspected in diabetic patients who have pyelonephritis and fail to respond to antibiotic treatment. The diagnosis and management should be quickly performed. In this article we have attempted to summarize current knowledge regarding EP.Keywords: Pyelonephritis, diabetes mellitusTurkiye Klinikleri J Med Sci 2004, 24:661-663
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