Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Urol Int 2007;78:13–22 DOI: 10.1159/000096929 Presentation and Outcome of Emphysematous Renal Tract Disease in Patients with Diabetes Mellitus Pinaki Dutta a Anil Bhansali a S.K. Singh b K.L. Gupta c M.H. Bhat a S.R. Masoodi a Yashwant Kumar d Departments of a Endocrinology, b Urology, c Nephrology and d Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India and cystitis, and 1 patient had EPN with cholecystitis, and 1 patient had EPN with pyomyositis. Only 7 (35%) patients had a history of pneumaturia. Escherichia coli was the common- est microorganism. The radiological distribution in 18 (2 had isolated cystitis) patients with EPN was: 2 patients had class 1; 1 had class 2; 2 had class 3A; 11 had class 3B, and 2 had class 4. Of 20 patients 11 (55%) survived. However, those patients who died had severe EPN based on radiological class (6 had class 3B and 1 had class 4). There was no significant differ- ence between the survivor and non-survivor groups with re- spect to age, gender, duration of diabetes mellitus, duration of symptoms, serum creatinine level, total leukocyte count, hemoglobin, platelet count and culture positivity. Conclu- sion: Computerized tomographic class 3B or 4 is the most reliable predictor of outcome in patients with ERTD. Copyright © 2007 S. Karger AG, Basel Introduction Emphysematous renal tract disease (ERTD) has been defined as a necrotizing infection of the renal parenchy- ma and its surrounding areas resulting in gas collection in the renal parenchyma, collecting system, perinephric tissue and urinary bladder [1] . ERTD occurs exclusively (90%) in patents with diabetes mellitus (DM), but occa- sionally in patients with obstructive uropathy, polycystic kidney disease, end-stage renal disease and on immuno- Key Words Renal tract disease, emphysematous  Diabetes mellitus  Pyelonephritis  Cystitis  Cholecystitis  Pyomyositis  Escherichia coli Abstract Background: Emphysematous renal tract disease (ERTD) is a rare necrotizing infection of the renal parenchyma and uri- nary tract caused by gas-producing organisms. ERTD de- serves special attention because of its life-threatening po- tential. Objectives: To study the clinical features, radiological classification and prognostic factors of ERTD; and to com- pare the modalities of management and the outcome among the various radiological classes of ERTD. Patients and Meth- ods: Twenty consecutive patients with diabetes and ERTD, seen over last 3 years in a tertiary care institute of north India, were included in the study. All patients were subjected to computerized tomography (CT) after initial diagnosis by ul- trasonography. They were classified into 5 classes as previ- ously described. All patients included in the study were con- servatively managed with appropriate antibiotics and/or percutaneous drainage or surgery if required. Result: Mean age ( 8 SD) of these subjects was 54.4 8 20.6 years; duration of diabetes mellitus 8.6 8 5.8 years, and duration of symp- toms related with ERTD ranged from 3 days to 3 months. Two patients had isolated emphysematous cystitis, 13 patients had emphysematous pyelonephritis (EPN), 3 had both EPN Internationalis Urologia Dr. Anil Bhansali Department of Endocrinology Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India) Tel. +91 172 274 7585 600/ext. 6583, Fax +91 172 274 4401 E-Mail anilbhansali_endocrine@rediffmail.com © 2007 S. Karger AG, Basel 0042–1138/07/0781–0013$23.50/0 Accessible online at: www.karger.com/uin