EMPHYSEMATOUS PYELITIS : epidemiological, therapeutic and evolutive features


Amine Derouiche
Rabii El Attat
Hassen Hentati
Mehdi Blah
Anis Slama
Mohamed Chebil


Aim : Emphsematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis.
Methods : The data of six patients managed for emphysematous pyelitis were collected and analyzed.
Results : The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned – dedifferentiated – renal parenchyma. Outcome was good.
Conclusion : Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy.


Emphysematous, pyelitis, urinary lithiasis, antibiotics, drainage



  1. Wan YL, Lee TY, Bullard MJ, et al: Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology 1996; 198:433-438.
  2. Joseph RC, Amendola MA, Artze ME, et al: Genitourinary tract gas: imaging evaluation. RadioGraphics 1996;16:295-308.
  3. Roy C, Pfleger DD, Tuchmann CM, et al: Emphysematous pyelitis: findings in five patients Radiology 2001;218:647-50.
  4. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000; 160 :797-805.
  5. Evanoff GV, Thompson CS, Foley R, et al: Spectrum of gas within the kidney: emphysematous pyelonephritis and emphysematous pyelitis. Am J Med 1987; 83:149-154.
  6. Bohlman ME, Sweren BS, Khazan R: Emphysematous pyelitis and emphysematous pyelonephritis characterized by computerized tomography. South Med J 1991 ;84:1438-43.
  7. Kaiser E., Fournier R : Pyélonéphrite emphysémateuse : diagnostic et traitement. Ann Urol 2005 ; 39 : 49-60.
  8. Ajay K, John H, Turney Aleck MT, et al: Unusual bacterial infections of the urinary tract in diabetic patients-rare but frequently lethal. Neph Dial Transplant 2001 ; 16:1062-5.
  9. Michaeli J., Mogle D., Pelberg S., et al: Emphysematous pyelonephritis. J Urol 1984;131: 203-8.
  10. Jeng-Jong H, Kuan-Wen R. Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection. J Urol 1991; 146:148-151.
  11. Rasoul M, Keyvan R. Emphysematous Urinary Tract Infections: Diagnosis, Treatment and Survival. Am J Med Sci 2007 ;333:111-6.