Bilateral Emphysematous Pyelonephritis with Portal Venous Gas
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Bilateral Emphysematous Pyelonephritis with Hepatic Portal Venous Gas: Case Report
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:
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Mao Li CHENG, Hasnizal NORDING, Chen Hong LIM
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Bilateral Emphysematous Pyelonephritis with Hepatic Portal Venous Gas: Case Report
Year: 2015
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Emphysematous pyelonephritis (EPN) is a rare and life-threatening condition characterized by a severe acute necrotizing infection of the renal parenchyma and its surrounding tissues, predominantly affecting diabetic patients. A notable yet uncommon association with EPN is hepatic portal venous gas (HPVG), which signals significant underlying abdominal pathology. Management strategies for EPN have shifted over the years from immediate nephrectomy to less invasive medical therapies. This report highlights a case of a diabetic woman with bilateral EPN and HPVG, successfully treated with medical management despite several adverse prognostic factors, including acute renal failure and thrombocytopenia.
The Significance of Hepatic Portal Venous Gas
HPVG, initially documented in infants with necrotizing enterocolitis, has emerged as a concerning radiological finding in adults presenting with EPN. While the exact mechanisms linking HPVG to EPN remain unclear, it is hypothesized that gas-forming bacteria from the infected kidney may disseminate into the portal venous system, potentially via hematogenous spread. Historically, the prognosis of HPVG has been grim, with high mortality rates typically associated with it; however, advancements in imaging and treatment approaches have improved outcomes. In this case, the patient presented with bilateral EPN and exhibited HPVG, yet her condition improved significantly with medical management, underscoring the potential for conservative treatment strategies even in severe cases.
Conclusion
The report indicates that EPN is a critical condition, especially in patients with diabetes, and that the occurrence of HPVG further complicates the clinical picture. Notably, HPVG should not be considered an absolute indication for urgent surgical intervention, as effective medical management can lead to positive outcomes. This case emphasizes the importance of early diagnosis, comprehensive resuscitation, and intensive multidisciplinary care in treating EPN, revealing that with appropriate management, even cases with severe presentations, such as HPVG, may be successfully treated without necessitating nephrectomy.
FAQ section (important questions/answers):
What is emphysematous pyelonephritis and its main cause?
Emphysematous pyelonephritis (EPN) is a rare, life-threatening infection of the kidney. It is often caused by a severe acute necrotizing infection of the renal parenchyma and typically occurs in patients with diabetes.
How is hepatic portal venous gas related to EPN?
Hepatic portal venous gas (HPVG) is an uncommon finding associated with serious abdominal diseases. In EPN cases, it suggests the presence of gas-forming bacteria that may enter the hepatic portal venous system, indicating a potentially severe condition.
What recent treatments are available for emphysematous pyelonephritis?
Management of EPN has shifted from immediate nephrectomy to medical therapy. Current treatment involves aggressive resuscitation, antibiotic administration, and in some cases, intensive care management, rather than always resorting to surgical intervention.
What was unique about the reported case of EPN?
The reported case was notable for being the first instance of bilateral emphysematous pyelonephritis associated with hepatic portal venous gas. It was successfully managed medically despite the presence of poor prognostic factors.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Bilateral Emphysematous Pyelonephritis with Portal Venous Gas”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Blood:
Blood plays a crucial role in diagnosing and managing conditions like emphysematous pyelonephritis. In this case, blood tests revealed important indicators such as high leukocyte count, elevated urea, and serum creatinine levels, which helped confirm acute renal failure and guide appropriate medical treatment decisions, emphasizing its significance in clinical assessments.
2) Disease:
The text discusses a rare and life-threatening disease known as emphysematous pyelonephritis, particularly prevalent in diabetic patients. Understanding this disease is vital for healthcare providers, as its timely diagnosis and innovative treatment approaches can significantly improve patient outcomes, illustrating the importance of recognizing and addressing serious health conditions.
3) Antibiotic (Antibacterial):
Antibiotics, particularly meropenem in this context, are essential in treating infections like emphysematous pyelonephritis. The administration of antibiotics can significantly assist in controlling bacterial growth, preventing further complications, and facilitating recovery, showcasing their critical role in modern medicine, particularly for serious, underlying infections associated with high mortality rates.
4) Indian:
The presence of an Indian context in the study indicates the setting for the reported case of bilateral emphysematous pyelonephritis. Such cultural and geographical factors can influence medical practices, patient demographics, and health challenges, emphasizing the importance of understanding local contexts in medical research and treatment protocols.
5) Table:
The term 'table' does not specifically appear in the text, yet it likely refers to data organization. In medical literature, tables are commonly utilized to summarize vital statistics, study findings, or treatment protocols, allowing healthcare professionals to digest complex information quickly and efficiently, facilitating better clinical decision-making.
6) Life:
The term 'life' in the context of emphysematous pyelonephritis emphasizes the life-threatening nature of the condition. Prompt medical attention is crucial to safeguard patients' lives, as timely diagnosis and intervention can significantly reduce mortality rates associated with severe infections and inadequate medical responses to critical health situations.
7) Sahani:
Sahani's mention refers to a key contributor in the field of gastroenterology. As a reputed figure, their work enhances understanding of conditions like hepatic portal venous gas, which is a significant finding associated with serious diseases. Their research outcomes can guide clinical practices and patient management strategies within medical communities.
8) Kumar:
Kumar is integral to the study as an author, reflecting the collaborative nature of medical research. Their contributions to case reporting enhance the understanding of complex conditions like emphysematous pyelonephritis, enabling healthcare professionals to share vital clinical evidence that can inform and improve treatment practices and patient outcomes.
9) Chang:
Chang's involvement signifies an essential contribution to the awareness of hepatic portal venous gas related to emphysematous pyelonephritis. Their research helps elucidate this rare association, thereby improving knowledge in the medical field, potentially guiding more effective management options and fostering a more comprehensive understanding of various medical complications.
10) Pain:
Pain is a significant symptom that prompted the medical assessment of the patient in the case report. Understanding the location and intensity of pain aids clinicians in diagnosing severe conditions like emphysematous pyelonephritis and determining appropriate interventions, highlighting the critical role of symptom evaluation in medical practice.
11) Shun (Sun):
Shun's mention implies a contribution to understanding emphysematous pyelonephritis and its management. Their research efforts enhance the understanding of clinical outcomes related to medical therapy, emphasizing the need for constant evaluation of treatment protocols and the sharing of knowledge among healthcare providers for improving patient outcomes.
12) Pur:
The term 'poor' refers to prognostic indicators such as poor renal function and low platelet counts associated with severe diseases like emphysematous pyelonephritis. Identifying poor prognostic factors is essential for clinicians to evaluate potential treatment outcomes, risks, and the urgency of intervention, significantly shaping patient management strategies.
13) Operative treatment:
Operative treatment, here referring to nephrectomy, is traditionally considered in severe cases of emphysematous pyelonephritis. Evaluating the necessity for surgical intervention against conservatively managing such conditions informs clinical decision-making processes, allowing practitioners to tailor treatment plans according to individual patient circumstances and prognostic factors.
14) Discussion:
Discussion is crucial in medical literature as it allows researchers and clinicians to share their insights on case management and treatment outcomes. It provides a platform for evaluating findings, comparing with existing literature, and drawing conclusions that could lead to improved clinical practices and understanding of complex medical conditions.
15) Collecting:
The term collecting likely pertains to the collecting system of the kidney, which is involved in the context of emphysematous pyelonephritis. Understanding the anatomical structures affected by such infections is critical, as it helps medical professionals grasp the implications of infections and inform appropriate treatment strategies for kidney-related conditions.
16) Swallowed:
Swallowed refers to the potential mechanism by which gases may enter the portal venous system, particularly under certain pathophysiological conditions. Understanding this mechanism helps healthcare professionals trace the origins of symptoms and complications, enhancing their ability to diagnose and strategize treatment effectively for conditions like hepatic portal venous gas.
17) Medicine:
Medicine encompasses the art and science of healing, which is reflected in the treatment strategies and patient care approaches discussed in the case report. An understanding of both medical theory and practice is essential for healthcare providers to effectively manage conditions like emphysematous pyelonephritis and associated complications, ensuring optimal patient outcomes.
18) Pulse:
Pulse is a vital sign that provides insight into a patient's cardiovascular status and overall health. Monitoring pulse rate is crucial in assessing critical patients, such as those with emphysematous pyelonephritis, as fluctuations can indicate deterioration or improvement in their clinical condition, guiding appropriate medical interventions based on these observations.
19) Fever:
Fever often signifies an underlying infection or inflammatory process, making it a significant clinical marker in the assessment of diseases like emphysematous pyelonephritis. Recognizing fever's role in the context of acute illnesses helps clinicians gauge disease severity and response to treatment, shaping clinical judgment during patient management.
20) Vena:
Vena, likely referring to 'vena cava', is critical in the context of associated vascular complications in severe infections. Understanding its anatomy and physiology aids in assessing potential risks, such as gas migration in cases of emphysematous pyelonephritis, informing treatment decisions and the overall care of affected patients.
21) Diet:
Diet plays a role in managing patients with chronic conditions like diabetes mellitus, which can predispose individuals to infections such as emphysematous pyelonephritis. Nutritional management is important for optimizing overall health, controlling blood glucose levels, and staving off potential complications, thus emphasizing the holistic approach in patient care.
22) Post:
Post likely refers to a 'post-treatment' context, emphasizing the importance of follow-up and monitoring after initial interventions in cases like emphysematous pyelonephritis. Addressing post-treatment evaluations is crucial in assessing recovery, managing any lingering effects, and adapting future care strategies to improve long-term patient health outcomes.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘Bilateral Emphysematous Pyelonephritis with Portal Venous Gas’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Medical treatment, Abdominal disease, Diabetes mellitus, General ward, Acute Renal Failure, Mortality Rate, Conservative management, General condition, Obstructive uropathy, Urine examination, Renal failure, Computed tomography scan, Blood glucose, Medical management, Thrombocytopenia, Blood investigation, Follow up care, Intensive care, Multidisciplinary management, Diabetic patient, Immunocompromised patient, Multidisciplinary team, Medical therapy, Platelet transfusion, Non-operative treatment, Insulin infusion, Gas forming bacteria, Renal parenchyma, High-dependency unit, Aggressive resuscitation, Poor prognostic factor, Intravenous antibiotic, Portal venous gas, Oral amoxicillin.