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Emphysematous pyelonephritis in children: Lessons from a case report and systematic review.

K V Aparna·Mohnish Darshan·Avani Kulkarni·P Athira·Amber Kumar·Mahesh Maheshwari·Shikha Malik·Girish Chandra Bhatt
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Abstract

BACKGROUND: Emphysematous pyelonephritis (EPN) is a rare, life-threatening gas-producing renal infection. Literature on pediatric EPN remains scarce. OBJECTIVE: To describe a case of pediatric EPN and systematically review the data on clinical presentations, diagnostic modalities, management strategies, and prognosis in pediatric emphysematous pyelonephritis. METHODS: A comprehensive search in PubMed, Embase and Web of Science using defined search terms was done, along with the Joanna Briggs Institute (JBI) critical appraisal checklist for quality assessment. RESULTS: Of 100 records, 20 studies (n = 21) were included in the review. The median (IQR) age of presentation was 48 (8-138) months. The major risk factor was reflux/obstructive nephropathy (52.3 %), and E. coli was the common organism. Management included antibiotics (47.6 %), minimally invasive procedures (33.3 %), or nephrectomy (19 %). We additionally report an adolescent girl with Type 1 diabetes mellitus and class 3A right-sided EPN. She improved with antibiotics and percutaneous nephrostomy (PCN) insertion. CONCLUSION: Obstructive or reflux nephropathy is a major risk factor for pediatric EPN. Antibiotics are the mainstay for treatment with supportive management. Refractory cases may require percutaneous drainage or partial/total nephrectomy.

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HumansEmphysematous PyelonephritisFemaleAnti-Bacterial AgentsChildAdolescentNephrostomy, PercutaneousChild, PreschoolPyelonephritisComputed Tomography (CT)Emphysematous pyelonephritis (EPN)Huang and Tseng classifcationObstructive uropathyPercutaneous nephrostomy (PCN)Journal ArticleSystematic ReviewCase ReportsReview

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K V Aparna, Mohnish Darshan, Avani Kulkarni, P Athira, Amber Kumar, Mahesh Maheshwari, Shikha Malik, Girish Chandra Bhatt. 2026-05-22. Emphysematous pyelonephritis in children: Lessons from a case report and systematic review.. https://doi.org/10.1016/j.jpurol.2026.106040

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Adolescent subjectAnti-Bacterial Agents subjectChild subjectChild, Preschool subjectFemale subjectHumans subjectJournal Article subjectSystematic reviews study

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