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. 2015 Nov;9(11):PC09-11.
doi: 10.7860/JCDR/2015/16763.6795. Epub 2015 Nov 1.

Role of Conservative Management in Emphysematous Pyelonephritis - A Retrospective Study

Sholay Meitei Kangjam  1 , Keshorjit Singh Irom  2 , Ibomcha Singh Khumallambam  3 , Rajendra Singh Sinam  4
Affiliations

Role of Conservative Management in Emphysematous Pyelonephritis - A Retrospective Study

Sholay Meitei Kangjam et al. J Clin Diagn Res. 2015 Nov.

Abstract

Introduction: Emphysematous pyelophritis (EPN) is a serious condition with significant mortality. The prognosis of patients with EPN has changed over the years. Mortality has declined with prompt and aggressive medical management and minimally invasive strategies.

Aim: To identify the prognostic factors and assess the outcome of conservative management of emphysematous pyelonephritis.

Settings and design: This was a retrospective study of 8 consecutive patients who were diagnosed with EPN in two medical institutes between July 2010 and June 2015.

Materials and methods: Eight consecutive patients diagnosed with emphysematous pyelonephritis between July 2010 and June 2015 was studied retrospectively. On the basis of Computerised tomographic scan findings they were grouped into four classes (1 to 4) according the modified classification recommended by Huang and Tseng. The management was conservative (combination of percutaneous drainage and antibiotics), immediate nephrectomy or delayed nephrectomy (when conservative management failed). Demographic, clinical, biochemical and radiological characteristics were assessed and compared between survivors and nonsurvivors.

Results: Seven (87.5%) of a total of 8 patients had diabetes mellitus. Escherichia coli (71.4 %) was the most common offending pathogen identified in pus culture. With conservative management in 7 patients (combination of percutaneous drainage and antibiotics), treatment was successful in 57.14 % and with immediate nephrectomy (one patient), the success rate was 100%. The risk factors for mortality were thrombocytopenia, shock and altered sensorium at presentation. The mortality rate in class 1, 2 and 3 was 0%, 33.3% and 66.7%. None of the patient had class 4 EPN.

Conclusion: A combination of percutaneous drainage with antibiotics offers an effective therapy for emphysematous pyelonephritis.

Keywords: Percutaneous drainage; Perinephric tissue; Risk factors; Upper urinary tract.

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Figures

[Table/Fig-4]:
[Table/Fig-4]:
Class 2 emphysematous pyelonephritis. Computed tomographic scan shows right sided EPN with extension of gas into the perinephric space (arrowhead)
See this image and copyright information in PMC

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