A Single-Center Review of Clinical Profile, Prognostic Factors, and Outcomes of Emphysematous Pyelonephritis ─ A Retrospective Study

Abstract

Background: Emphysematous pyelonephritis (EPN) is an uncommon life-threatening condition characterized by the production of gases within the renal parenchyma and perirenal space. We aimed to study the clinical features, radiological classification, prognostic factors of EPN, and outcome among the various radiological classes of EPN. Methods: All the patients who were admitted to the urology ward of our Institute were included and the study period was for the last 5 years. It was a retrospective study and the collection of file records were done from the medical record section department of our Institute. Results: Overall 20 cases were diagnosed to have emphysematous pyelonephritis. There were 12 females and 8 males and the majority of the patients were from (40-50) age groups. Eighteen cases had type 2 diabetes mellitus and two patients had upper ureteric calculus. 16 cases had unilateral involvement, 3 had bilateral involvement and one patient had solitary kidney with EPN. 12 cases were classified as having class 1 or 2 diseases and eight cases had class 3 and 4 diseases. The most common clinical presentations were flank pain (95%) and fever (85%). The most common organism cultured was Escherichia Coli (E. coli) (70%). Most of the cases were managed by percutaneous nephrostomy drainage (PCN) of the collecting system with medical management. Shock at admission (p=0.009), serum creatinine >5.0 mg/dl (p= 0.031) and DIC (p= 0.045) were independent poor prognostic factors. Conclusions: Early control of blood sugar with vigorous hydration and appropriate intravenous extended-spectrum antibiotic should be the initial treatment of choice. Early percutaneous nephrostomy should be tried even in advanced stages. Shock, DIC and Serum creatinine >5mg/dl on admission are independent predictors of poor outcome