Emphysematous Pyelonephritis (EPN): Symptoms & Treatment

Instructor: Artem Cheprasov
Emphysematous pyelonephritis is a very serious infectious disorder that can result in a person's death. Find out what this is, what its signs and symptoms can be, and what its potential treatment options are.

Emphysematous Pyelonephritis

You've probably heard of a lung disorder called emphysema. This condition involves the pathologic accumulation of gas (air) within the lungs. When a gas is pathologically found in any tissue, we generally call this 'emphysema' or 'emphysematous'.

'Pyelonephritis' is the technical term for a kidney infection. So, emphysematous pyelonephritis is then a kidney infection with the production and presence of gas within or around the kidney. Emphysematous pyelonephritis is sometimes called renal (kidney) emphysema as well.

Let's learn more about this condition's signs, symptoms, and treatment.

Signs & Symptoms

What would you expect in a patient with emphysematous pyelonephritis? Most patients will have pyrexia, or a fever. Most patients will also report abdominal pain or pain on the side of their body. Close to half of people with emphysematous pyelonephritis will by thrombocytopenic. Thrombocytopenia refers to an abnormally low platelet count.

Other possible signs and symptoms include:

  • Dyspnea, difficulty breathing or shortness of breath
  • Nausea and vomiting
  • Lethargy
  • Evidence of kidney dysfunction on blood tests
  • Shock, which refers to the inadequate delivery of oxygenated blood to the tissues
  • Altered consciousness or mental awareness, such as confusion

The most important sign to look for in terms of diagnosing the condition is actually found on radiographic imagery such as x-rays and CT scans. This will reveal the presence of gas in the kidneys where the gas can be seen as a streaky, bubbly, or mottled pattern in the kidneys.


This condition is most often caused by gas-producing microorganisms called bacteria, especially E. coli. However, it can also be caused by parasites or fungi. Thus, any medical management is eventually tailored to the identified causative agent. For example, antibiotics are given to treat bacterial infections. One example of such an antibiotic is carbapenem.

Percutaneous drainage is also performed. This refers to inserting a catheter through the person's skin and into their kidney, in order to help remove things like gas or pus from the kidneys.

An important treatment consideration is a nephrectomy, the removal of the kidney from the body. This is especially the case with people experiencing severe cases of emphysematous pyelonephritis.

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