Pielonefritis enfisematosa: Revisión de la fisiopatología y tratamiento
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v79i1.390Palabras clave:
Pielonefritis enfisematosa, sepsis, factores pronósticosResumen
La pielonefritis enfisematosa es una emergencia urológica caracterizada por una infección parenquimatosa y perinéfrica, aguda necrosante, causada por uropatógenos formadores de gas. Es considerada una entidad poco común, teniendo una mayor incidencia en países en vías de desarrollo. Si bien, la patogenia no está bien comprendida existen varios factores bien identificados que se encuentran envueltos en un espectro de elementos que tienen por resultado la producción de gas en el parénquima renal. Varios factores de mal pronóstico asociados a una alta mortalidad han sido identificados en diferentes cohortes. Típicamente podemos dividir el tratamiento de estos pacientes en manejo médico, manejo médico y drenaje endoscópico o percutáneo y nefrectomía de urgencia.; sin embargo, al existir muy pocas guías clínicas o algoritmos de tratamiento, no hay un consenso en el manejo que deben tener estos pacientes.
Referencias
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2. Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU Int. 2011;107(9):1474-8.
3. Wan YL, Lo SK, Bullard MJ, Chang PL, Lee TY. Predictors of outcome in emphysematous pyelonephritis. J Urol. 1998;159(2):369-73.
4. Aswathaman K, Gopalakrishnan G, Gnanaraj L, Chacko NK, Kekre NS, Devasia A. Emphysematous pyelonephritis: outcome of conservative management. Urology. 2008;71(6):1007-9.
5. Kapoor R, Muruganandham K, Gulia AK, Singla M, Agrawal S, Mandhani A, et al. Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis. BJU Int. 2010;105(7):986-9.
6. Olvera-Posada D, Armengod-Fischer G, Vázquez-Lavista LG, Maldonado-Ávila M, Rosas-Nava E, Manzanilla-García H, et al. Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico. Urology. 2014;83(6):1280-4.
7. Tseng C-C, Wu J-J, Wang M-C, Hor L-I, Ko Y-H, Huang J-J. Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Am J Kidney Dis Off J Natl Kidney Found. 2005;46(3):432-9.
8. Lin W-R, Chen M, Hsu J-M, Wang C-H. Emphysematous pyelonephritis: patient characteristics and management approach. Urol Int. 2014;93(1):29-33.
9. Kolla PK, Madhav D, Reddy S, Pentyala S, Kumar P, Pathapati RM. Clinical Profile and Outcome of Conservatively Managed Emphysematous Pyelonephritis. ISRN Urol [Internet]. 2012 [citado 2 de abril de 2019];2012. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329657/
10. Peng C-Z, Chen Y-C, How C-K. Emphysematous pyelonephritis with intraperitoneal air dissection. Eur Geriatr Med [Internet]. 2016 [citado 2 de abril de 2019];7(6):589-90. Disponible en: https://www.em-consulte.com/en/article/1097368
11. Hu S-Y, Lee B-J, Tsai C-A, Hsieh M-S. Concurrent emphysematous pyelonephritis, cystitis, and iliopsoas abscess from discitis in a diabetic woman. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2016;51:105-6.
12. Chauhan V, Sharma R. Emphysematous pyelonephritis (class IIIa) managed with antibiotics alone. Hong Kong Med J Xianggang Yi Xue Za Zhi. 2015;21(4):363-5.
13. Crouter AJ, Abraham MK, Wilkerson RG. Emphysematous pyelonephritis in a renal allograft. Am J Emerg Med. 2017;35(3):520.e1-520.e2.
14. Min JW, Lee SK, Ko YM, Kwon KW, Lim JU, Lee YB, et al. Emphysematous pyelonephritis initially presenting as a spontaneous subcapsular hematoma in a diabetic patient. Kidney Res Clin Pract [Internet]. 2014 [citado 2 de abril de 2019];33(3):150-3. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714164/
15. Sodhi KS, Lal A, Vyas S, Verma S, Khandelwal N. Emphysematous pyelonephritis with emphysematous pancreatitis. J Emerg Med. 2010;39(1):e85-87.
16. Olvera-Posada D, García-Mora A, Culebro-García C, Castillejos-Molina R, Sotomayor M, Feria-Bernal G, et al. Factores pronósticos en pielonefritis enfisematosa. Actas Urol Esp [Internet]. 2013 [citado 2 de abril de 2019];37(4):228-32. Disponible en: http://www.elsevier.es/es-revista-actas-urologicas-espanolas-292-articulo-factores-pronosticos-pielonefritis-enfisematosa-S0210480612003269
17. Lu Y-C, Chiang B-J, Pong Y-H, Huang K-H, Hsueh P-R, Huang C-Y, et al. Predictors of failure of conservative treatment among patients with emphysematous pyelonephritis. BMC Infect Dis. 2014;14:418.
18. Khaira A, Gupta A, Rana DS, Gupta A, Bhalla A, Khullar D. Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis. Int Urol Nephrol. 2009;41(4):959-66.
19. Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk factors for mortality in patients with emphysematous pyelonephritis: a meta-analysis. J Urol. 2007;178(3 Pt 1):880-5; quiz 1129.
20. Pontin AR, Barnes RD. Current management of emphysematous pyelonephritis. Nat Rev Urol. 2009;6(5):272-9.
21. Fatima R, Jha R, Muthukrishnan J, Gude D, Nath V, Shekhar S, et al. Emphysematous pyelonephritis: A single center study. Indian J Nephrol [Internet]. 2013 [citado 2 de abril de 2019];23(2):119-24. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658289/
22. Tsu JH-L, Chan C-K, Chu RW-H, Law I-C, Kong C-K, Liu P-L, et al. Emphysematous pyelonephritis: an 8-year retrospective review across four acute hospitals. Asian J Surg. 2013;36(3):121-5.
23. Uruc F, Yuksel OH, Sahin A, Urkmez A, Yildirim C, Verit A. Emphysematous pyelonephritis: Our experience in managing these cases. Can Urol Assoc J [Internet]. 2015 [citado 2 de abril de 2019];9(7-8):E480-3. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514496/
24. Lu Y-C, Hong J-H, Chiang B-J, Pong Y-H, Hsueh P-R, Huang C-Y, et al. Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis: 51 Cases and 14-Year-Experience of a Tertiary Referral Center. Medicine (Baltimore). 2016;95(21):e3573.
25. Bhat RA, Khan I, Khan I, Palla N, Mir T. Emphysematous pyelonephritis: Outcome with conservative management. Indian J Nephrol [Internet]. 2013 [citado 2 de abril de 2019];23(6):444-7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841514/
26. Royle J, Williamson R, Strachan M, O’Donnell M, Jackson S, Argryopoulos T, et al. Emphysematous Pyelonephritis Successfully Treated with Laparoscopic Nephrectomy. Br J Med Surg Urol [Internet]. 2009 [citado 2 de abril de 2019];2(5):204-7. Disponible en: https://journals.sagepub.com/doi/abs/10.1016/j.bjmsu.2009.05.004
27. Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N’Dow J, et al. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008;179(5):1844-9.
28. Nana GR, Brodie A, Akhter W, Karim O, Motiwala H. Nephroureterectomy for emphysematous pyelonephritis: An aggressive approach is sometimes necessary. A case report and literature review. Int J Surg Case Rep. 2015;10:179-82.
2. Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU Int. 2011;107(9):1474-8.
3. Wan YL, Lo SK, Bullard MJ, Chang PL, Lee TY. Predictors of outcome in emphysematous pyelonephritis. J Urol. 1998;159(2):369-73.
4. Aswathaman K, Gopalakrishnan G, Gnanaraj L, Chacko NK, Kekre NS, Devasia A. Emphysematous pyelonephritis: outcome of conservative management. Urology. 2008;71(6):1007-9.
5. Kapoor R, Muruganandham K, Gulia AK, Singla M, Agrawal S, Mandhani A, et al. Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis. BJU Int. 2010;105(7):986-9.
6. Olvera-Posada D, Armengod-Fischer G, Vázquez-Lavista LG, Maldonado-Ávila M, Rosas-Nava E, Manzanilla-García H, et al. Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico. Urology. 2014;83(6):1280-4.
7. Tseng C-C, Wu J-J, Wang M-C, Hor L-I, Ko Y-H, Huang J-J. Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Am J Kidney Dis Off J Natl Kidney Found. 2005;46(3):432-9.
8. Lin W-R, Chen M, Hsu J-M, Wang C-H. Emphysematous pyelonephritis: patient characteristics and management approach. Urol Int. 2014;93(1):29-33.
9. Kolla PK, Madhav D, Reddy S, Pentyala S, Kumar P, Pathapati RM. Clinical Profile and Outcome of Conservatively Managed Emphysematous Pyelonephritis. ISRN Urol [Internet]. 2012 [citado 2 de abril de 2019];2012. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329657/
10. Peng C-Z, Chen Y-C, How C-K. Emphysematous pyelonephritis with intraperitoneal air dissection. Eur Geriatr Med [Internet]. 2016 [citado 2 de abril de 2019];7(6):589-90. Disponible en: https://www.em-consulte.com/en/article/1097368
11. Hu S-Y, Lee B-J, Tsai C-A, Hsieh M-S. Concurrent emphysematous pyelonephritis, cystitis, and iliopsoas abscess from discitis in a diabetic woman. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2016;51:105-6.
12. Chauhan V, Sharma R. Emphysematous pyelonephritis (class IIIa) managed with antibiotics alone. Hong Kong Med J Xianggang Yi Xue Za Zhi. 2015;21(4):363-5.
13. Crouter AJ, Abraham MK, Wilkerson RG. Emphysematous pyelonephritis in a renal allograft. Am J Emerg Med. 2017;35(3):520.e1-520.e2.
14. Min JW, Lee SK, Ko YM, Kwon KW, Lim JU, Lee YB, et al. Emphysematous pyelonephritis initially presenting as a spontaneous subcapsular hematoma in a diabetic patient. Kidney Res Clin Pract [Internet]. 2014 [citado 2 de abril de 2019];33(3):150-3. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714164/
15. Sodhi KS, Lal A, Vyas S, Verma S, Khandelwal N. Emphysematous pyelonephritis with emphysematous pancreatitis. J Emerg Med. 2010;39(1):e85-87.
16. Olvera-Posada D, García-Mora A, Culebro-García C, Castillejos-Molina R, Sotomayor M, Feria-Bernal G, et al. Factores pronósticos en pielonefritis enfisematosa. Actas Urol Esp [Internet]. 2013 [citado 2 de abril de 2019];37(4):228-32. Disponible en: http://www.elsevier.es/es-revista-actas-urologicas-espanolas-292-articulo-factores-pronosticos-pielonefritis-enfisematosa-S0210480612003269
17. Lu Y-C, Chiang B-J, Pong Y-H, Huang K-H, Hsueh P-R, Huang C-Y, et al. Predictors of failure of conservative treatment among patients with emphysematous pyelonephritis. BMC Infect Dis. 2014;14:418.
18. Khaira A, Gupta A, Rana DS, Gupta A, Bhalla A, Khullar D. Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis. Int Urol Nephrol. 2009;41(4):959-66.
19. Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk factors for mortality in patients with emphysematous pyelonephritis: a meta-analysis. J Urol. 2007;178(3 Pt 1):880-5; quiz 1129.
20. Pontin AR, Barnes RD. Current management of emphysematous pyelonephritis. Nat Rev Urol. 2009;6(5):272-9.
21. Fatima R, Jha R, Muthukrishnan J, Gude D, Nath V, Shekhar S, et al. Emphysematous pyelonephritis: A single center study. Indian J Nephrol [Internet]. 2013 [citado 2 de abril de 2019];23(2):119-24. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658289/
22. Tsu JH-L, Chan C-K, Chu RW-H, Law I-C, Kong C-K, Liu P-L, et al. Emphysematous pyelonephritis: an 8-year retrospective review across four acute hospitals. Asian J Surg. 2013;36(3):121-5.
23. Uruc F, Yuksel OH, Sahin A, Urkmez A, Yildirim C, Verit A. Emphysematous pyelonephritis: Our experience in managing these cases. Can Urol Assoc J [Internet]. 2015 [citado 2 de abril de 2019];9(7-8):E480-3. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514496/
24. Lu Y-C, Hong J-H, Chiang B-J, Pong Y-H, Hsueh P-R, Huang C-Y, et al. Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis: 51 Cases and 14-Year-Experience of a Tertiary Referral Center. Medicine (Baltimore). 2016;95(21):e3573.
25. Bhat RA, Khan I, Khan I, Palla N, Mir T. Emphysematous pyelonephritis: Outcome with conservative management. Indian J Nephrol [Internet]. 2013 [citado 2 de abril de 2019];23(6):444-7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841514/
26. Royle J, Williamson R, Strachan M, O’Donnell M, Jackson S, Argryopoulos T, et al. Emphysematous Pyelonephritis Successfully Treated with Laparoscopic Nephrectomy. Br J Med Surg Urol [Internet]. 2009 [citado 2 de abril de 2019];2(5):204-7. Disponible en: https://journals.sagepub.com/doi/abs/10.1016/j.bjmsu.2009.05.004
27. Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N’Dow J, et al. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008;179(5):1844-9.
28. Nana GR, Brodie A, Akhter W, Karim O, Motiwala H. Nephroureterectomy for emphysematous pyelonephritis: An aggressive approach is sometimes necessary. A case report and literature review. Int J Surg Case Rep. 2015;10:179-82.
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2019-04-08
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