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首页> 外文期刊>Nature reviews. Urology >Current management of emphysematous pyelonephritis
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Current management of emphysematous pyelonephritis

机译：气肿性肾盂肾炎的当前管理

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Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal parenchymal infection that is characterized by the production of intraparenchymal gas. EPN predominantly affects female diabetics, and can occur in insulin-dependent and non-insulin-dependent patients in the absence of ureteric obstruction. Nondiabetic patients can also develop EPN, but often have ureteric obstruction and do not seem to develop such extensive disease. One gaseous component-carbon dioxide-is generated by bacterial fermentation of glucose (present in excess in diabetics) and acids. Patients with EPN show relatively vague symptoms initially, but frequently undergo a sudden deterioration in their condition, necessitating urgent medical attention. Treatment of patients with EPN comprises resuscitation, correction of any electrolyte and glucose problems, and administration of antibiotics targeting Gram-negative bacteria. Ureteric obstruction, if present, is relieved by a percutaneous nephrostomy or stent. Definitive management is by percutaneous drainage, except when there is extensive diffuse gas with renal destruction; in this case, a nephrectomy is advised. The requirement for a nephrectomy could potentially be avoided by early diagnosis and treatment of diabetics with urinary infection. With the advent of CT, a staging system of the gas patterns generated in the kidneys of EPN patients has evolved. Risk factors have been defined to aid management.
机译：气肿性肾盂肾炎（EPN）是一种严重的坏死性肾实质感染，其特征是实质性气体的产生。 EPN主要影响女性糖尿病患者，在没有输尿管梗阻的情况下，胰岛素依赖和非胰岛素依赖患者均可发生EPN。非糖尿病患者也可以发展为EPN，但经常患有输尿管梗阻并且似乎没有发展成如此广泛的疾病。一种气体成分二氧化碳是通过葡萄糖（在糖尿病患者中过量存在）和酸的细菌发酵产生的。患有EPN的患者起初表现出相对模糊的症状，但经常会突然病情恶化，需要紧急医疗救护。 EPN患者的治疗包括复苏，纠正任何电解质和葡萄糖问题以及施用针对革兰氏阴性细菌的抗生素。经皮肾造口术或支架可缓解输尿管梗阻。明确的治疗方法是经皮引流，除非有大量弥散性气体伴有肾脏破坏;在这种情况下，建议进行肾切除术。通过对尿路感染的糖尿病患者进行早期诊断和治疗，有可能避免进行肾脏切除术。随着CT的出现，EPN患者肾脏中产生的气体模式的分期系统已经发展。已经定义了风险因素以协助管理。

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