Pielonefritis enfisematosa: patogénesis, diagnóstico y manejo

Dra. Valeria Caro Pizarro
Médico General, San José, Costa Rica.
Investigador Independiente.
Miembro del Colegio de Médicos y Cirujanos de Costa Rica.
Costa Rica.

Dra. Rebeca Zumbado Vásquez
Médico General, Heredia, Costa Rica.
Investigador Independiente.
Miembro del Colegio de Médicos y Cirujanos de Costa Rica.
Costa Rica.

Dr. Kevin Hines Chaves
Médico General, San José, Costa Rica.
Investigador Independiente.
Miembro del Colegio de Médicos y Cirujanos de Costa Rica.
Costa Rica.

Resumen

La pielonefritis enfisematosa es una infección necrotizante del sistema urinario, producida por bacterias formadoras de gas. Su mayor incidencia se identifica en los pacientes diabéticos o inmunocomprometidos. Su diagnóstico es radiológico al confirmar la presencia de gas en el parénquima renal o tejido perirrenal, debido a que la clínica solo orientará al proceso infeccioso de origen renal.

Aún se debate su debido tratamiento, sin embargo, los autores que estudian el tema concuerdan en el cambio del manejo para preservar el parénquima renal en contraste con el manejo anterior, el cual correspondía a la nefrectomía. En esta revisión bibliográfica, se proveerá información acerca de la patogénesis, el diagnóstico, los factores pronósticos y las diferentes opciones que se han estudiado para su adecuado manejo.

Palabras claves

Pielonefritis enfisematosa, drenaje percutáneo, nefrectomía.

Abstract

Emphysematous pyelonephritis is a necrotizing infection of the urinary caused by gas producing bacteria. It has a higher incidence in diabetic or immunocompromised patients. Its diagnosis is made by confirming the presence of gas in the renal parenchyma or perirenal tissue by radiological images, because the clinical aspects will only orient to an infectious process of renal origin.

The corresponding treatment is still debated however the authors agree on the change of management towards the preservation of the renal parenchyma in contrast to the previous management which corresponded to nephrectomy. In this review information about the pathogenesis, diagnosis and different options that have been studied for the proper management for emphysematous pyelonephritis will be provided.

Keywords

Emphysematous pyelonephritis, percutaneous drainage, nephrectomy.

Bibliografía

Agrawal, S., Kalathia, J., Chipde, S. y Agrawal, R. (2015). Nephron-sparing surgery in case of emphysematous pyelonephritis. Urology Annals, 7(4), 504-506. doi:10.4103/0974-7796.162211

Ezzouine, H., Cherkaoui, A. y Benslama, A. (2016). Emphysematous pyelonephritis: Dilemma between radical or conservative treatment (report of 3 cases). Community Acquired Infection, 3(2), 61-67. doi:10.4103/2225-6482.184918

Kim, N. y Machnicki, S. (2015). Emphysematous pyelonephritis. Applied Radiology, 44. Recuperado de https://appliedradiology.com/articles/emphysematous-pyelonephritis

Lamy, S., Alsharif, M., Mohammedkhalil, A., Alsaywid, B. y Alhazmy, A. (2015). Emphysematous pyelonephritis: Is nephrectomy warranted? Urology Annals, 7(4), 494-498. doi:10.4103/0974-7796.158503

Misgar, R., Mubarik, I., Wani, A., Bashir, M., Ramzan, M. y Laway, B. (2016). Emphysematous pyelonephritis: A 10-year experience with 26 cases. Indian Journal of Endocrinology and Metabolism, 20(4), 475-481. doi:10.4103/2230-8210.183475

Nana, G. R., Brodie, A., Akhter, W., Karim, O. y Motiwala, H. (2015). Nephroureterectomy for emphysematous pyelonephritis: An aggressive approach is sometimes necessary. A case report and literature review. International Journal of Surgery Case Reports,10, 179-182. doi:10.1016/j.ijscr.2015.03.051

Pontin, A. R. y Barnes, R. D. (2009). Current management of emphysematous pyelonephritis. Nature Reviews Urology, 6(5), 272-279. doi:10.1038/nrurol.2009.51

Rao, V. V., Pathapati, D., Shinkar, P., Kumar, S., Jha, Dattatreya, P., . . . Chigurupati, M. (2017).

Asymptomatic emphysematous pyelonephritis - positron emission tomography computerized tomography aided diagnostic and therapeutic elucidation. Indian Journal of Nuclear Medicine, 32(1), 42-45. doi:10.4103/0972-3919.198477

Shah, V., Khade, A. y Lad, S. (2016). Pathology of emphysematous pyelonephritis: A study of 11 cases. Medical Journal of Dr. D.Y. Patil University, 9(6), 722-726. doi:10.4103/0975-2870.194191

Sokhal, A. K., Kumar, M., Purkait, B., Jhanwar, A., Singh, K., Bansal, A. y Sankhwar, S. (2017). Emphysematous pyelonephritis: Changing trend of clinical spectrum, pathogenesis, management and outcome. Türk Üroloji Dergisi/Turkish Journal of Urology, 43(2), 202-209. doi:10.5152/tud.2016.14227

Somani, B. K., Nabi, G., Thorpe, P., Hussey, J., Cook, J. y N’Dow, J. (2008). Is Percutaneous Drainage the New Gold Standard in the Management of Emphysematous Pyelonephritis? Evidence From a Systematic Review. Journal of Urology, 179(5), 1844-1849. doi:10.1016/j.juro.2008.01.019

Torres, L., García, M., Serrano, E., Maldonado, E., López, V., Montoya, G. y Moreno-Palacios, J. (2016). Factores pronósticos de morbimortalidad en pacientes con pielonefritis enfisematosa. Revista Medica Del IMSS, 54, S156-S161. Recuperado de http://search.ebscohost.com.ezproxy.sibdi.ucr.ac.cr:2048/login.aspx?direct=true&db=a9h&AN=120913933&site=ehost-live&scope=site

Tilden, W., Valliani, S. y Chana, H. S. (2015). Severe emphysematous pyelonephritis: Conservative management plus image-guided percutaneous drainage prior to successful elective nephrectomy. A case report and review of the literature. BJR|case Reports, 1(1), 20140004-20140007. doi:10.1259/bjrcr.20140004

Ubee, S. S., Mcglynn, L. y Fordham, M. (2010). Emphysematous pyelonephritis. BJU International, 107(9), 1474-1478. doi:10.1111/j.1464-410x.2010.09660.x

Vishnu, V., Vardhana, R. y Panduranga, K. (2018). A clinical study of emphysematous pyelonephritis. IAIM, 5(2), 150-159.

Wang, H., Zhu, X., Xu, X., Li, G., Liu, N., He, F. y Man, Lb. (2017). Emphysematous Pyelonephritis Treated with Vacuum Sealing Drainage. Chin Med,130, 247‐248. doi: 10.4103/0366‐6999.198021

Wiesel, S., Gutman, A., Abraham, J. E. y Kiroycheva, M. (2017). Foley Follies: Emphysematous Pyelitis from Instrumentation in Obstructive Uropathy. Cureus, 9(8), 1612-1617. doi:10.7759/cureus.1612

Arch Intern Med. 2000 Mar 27;160(6):797-805.
Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis.
Huang JJ1, Tseng CC.

Aswathaman K, Gopalakrishnan G, Gnanaraj L, Chacko NK, Kekre NS, Devasia A. Emphysematous pyelonephritis: outcome of conservative management. Urology. 2008; 71: 1007-1009.

Huang JJ, Tseng C. Emphysematous pyelonephritis. Cli-nicoradiological classification, management, prognosis,and pathogenesis. Arch Intern Med 2000;160:797-805.

Int Urol Nephrol. 2009 Dec;41(4):959-66. doi: 10.1007/s11255-009-9552-y. Epub 2009 Apr 30.

Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis.

Khaira A1, Gupta A, Rana DS, Gupta A, Bhalla A, Khullar D.