Morphological transition after medical treatment of emphysematous pyelonephritis over time—case report
Abstract Background Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. The treatment strategy, especially for surgical intervention, in EPN has been based on the Huang and Wan classifica...
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2025-04-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-025-04135-x |
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| author | Ukyo Yamamoto Motoka Yagame Daisuke Uchida Masumi Hara Hideyuki Takeuchi Hiroo Kawarazaki |
| author_facet | Ukyo Yamamoto Motoka Yagame Daisuke Uchida Masumi Hara Hideyuki Takeuchi Hiroo Kawarazaki |
| author_sort | Ukyo Yamamoto |
| collection | DOAJ |
| description | Abstract Background Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. The treatment strategy, especially for surgical intervention, in EPN has been based on the Huang and Wan classifications. Huang’s classification is based on the extent of gas and abscess spillover, while Wan’s classification is based on the morphology of gas and fluid retention. Wan’s classification type I EPN is considered more severe compared to type II EPN and pathophisyological mechanisms are speculated as the cause of the different presentation but the actual cause is unknown. In the present case, conservative treatment of EPN in the early stages of the disease allowed us to show that Wan’s classification may represent a time series of morphologic changes throughout EPN. Case presentation A 72-year-old woman treated for diabetes was admitted because of suspected treatment-resistant pyelonephritis. Her CT scan at presentation was suggestive of EPN and antibiotics was started. After additional medical treatment, a follow-up of CT image showed that the initial appearance of bubbly gas formation changed into a fluid-forming abscess. This transition shows that type I is an early phase image of EPN and type II image is seen following the early phase. Thereafter no change was seen in CT image and residing inflammation led to planned nephrectomy on day 35. Antibiotics were discontinued and no recurrence was confirmed. Conclusions Wan’s type I and II EPN has been often reported as different pathophysiological entities. Our case shows that these two subtypes may represent stages in the progression of EPN. Medical treatment for type I may permit safe nephrectomy for type II EPN. |
| format | Article |
| id | doaj-art-d5901c70edb44ae18538f072ebe02c71 |
| institution | DOAJ |
| issn | 1471-2369 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Nephrology |
| spelling | doaj-art-d5901c70edb44ae18538f072ebe02c712025-08-20T03:14:05ZengBMCBMC Nephrology1471-23692025-04-012611410.1186/s12882-025-04135-xMorphological transition after medical treatment of emphysematous pyelonephritis over time—case reportUkyo Yamamoto0Motoka Yagame1Daisuke Uchida2Masumi Hara3Hideyuki Takeuchi4Hiroo Kawarazaki5Department of Internal Medicine, Teikyo University Hospital MizonokuchiDepartment of Internal Medicine, Teikyo University Hospital MizonokuchiDepartment of Internal Medicine, Teikyo University Hospital MizonokuchiDepartment of Internal Medicine, Teikyo University Hospital MizonokuchiDepartment of Internal Medicine, Teikyo University Hospital MizonokuchiDepartment of Internal Medicine, Teikyo University Hospital MizonokuchiAbstract Background Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. The treatment strategy, especially for surgical intervention, in EPN has been based on the Huang and Wan classifications. Huang’s classification is based on the extent of gas and abscess spillover, while Wan’s classification is based on the morphology of gas and fluid retention. Wan’s classification type I EPN is considered more severe compared to type II EPN and pathophisyological mechanisms are speculated as the cause of the different presentation but the actual cause is unknown. In the present case, conservative treatment of EPN in the early stages of the disease allowed us to show that Wan’s classification may represent a time series of morphologic changes throughout EPN. Case presentation A 72-year-old woman treated for diabetes was admitted because of suspected treatment-resistant pyelonephritis. Her CT scan at presentation was suggestive of EPN and antibiotics was started. After additional medical treatment, a follow-up of CT image showed that the initial appearance of bubbly gas formation changed into a fluid-forming abscess. This transition shows that type I is an early phase image of EPN and type II image is seen following the early phase. Thereafter no change was seen in CT image and residing inflammation led to planned nephrectomy on day 35. Antibiotics were discontinued and no recurrence was confirmed. Conclusions Wan’s type I and II EPN has been often reported as different pathophysiological entities. Our case shows that these two subtypes may represent stages in the progression of EPN. Medical treatment for type I may permit safe nephrectomy for type II EPN.https://doi.org/10.1186/s12882-025-04135-xEmphysematous pyelonephritisComputed tomographyX-ray imageChanges in gas imageType2 diabetes |
| spellingShingle | Ukyo Yamamoto Motoka Yagame Daisuke Uchida Masumi Hara Hideyuki Takeuchi Hiroo Kawarazaki Morphological transition after medical treatment of emphysematous pyelonephritis over time—case report BMC Nephrology Emphysematous pyelonephritis Computed tomography X-ray image Changes in gas image Type2 diabetes |
| title | Morphological transition after medical treatment of emphysematous pyelonephritis over time—case report |
| title_full | Morphological transition after medical treatment of emphysematous pyelonephritis over time—case report |
| title_fullStr | Morphological transition after medical treatment of emphysematous pyelonephritis over time—case report |
| title_full_unstemmed | Morphological transition after medical treatment of emphysematous pyelonephritis over time—case report |
| title_short | Morphological transition after medical treatment of emphysematous pyelonephritis over time—case report |
| title_sort | morphological transition after medical treatment of emphysematous pyelonephritis over time case report |
| topic | Emphysematous pyelonephritis Computed tomography X-ray image Changes in gas image Type2 diabetes |
| url | https://doi.org/10.1186/s12882-025-04135-x |
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