In emphysematous pyelonephritis, percutaneous drainage — performed under CT guidance using tubes of good caliber — is an appropriate initial approach when there are localized areas of gas and functioning kidney tissue remains.
This protocol addresses the situation where that first-line drainage has not achieved resolution and a definitive next-line decision is required.
Percutaneous drainage (optimally CT-guided) is considered to have failed when follow-up CT imaging does not show disappearance of the gas and resolution of inflammation — a determination that may require up to 12 weeks of observation.
Failure to reach these imaging endpoints triggers escalation to this protocol.
For patients with extensive renal destruction who are fit for surgery and have not responded to drainage, this protocol involves a surgical intervention for a select group who meet defined criteria. The complete decision criteria, procedure selection, and management details are contained in the full protocol.
DOI: 10.1038/nrurol.2009.51
Emergency nephrectomy is advised for patients with extensive renal destruction.
This procedure is now limited to a select group of patients with EPN who are fit for surgery, and fulfill one or more of the following criteria: possession of a nonfunctioning kidney; presentation of gross renal parenchymal destruction; display of a class IIIa or IIIb gas pattern; existence of two or more risk factors.
Nephrectomy can be radical, simple or laparoscopic.
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