Introduction: Emphysematous pyelonephritis (EPN) is severe necrotizing infection of renal parenchyma mainly involving diabetic patient. Main modality of treatment for EPN is prompt medical therapy with antibiotic and percutaneous catheter drainage, nephrectomy is the last option for the patients not responding to renal preserving approaches or in situations with poor prognostic factors.
This study was conducted at tertiary care centre for interpreting the role of various renal preservation strategies applied for different grades of EPN.
Materials and Methods: We have done prospective analysis of clinical outcome of 35 patients suffering from EPN in twenty four months study period. These patients are treated by aggressive resuscitation, parenteral antibiotics, relieving the urinary tract obstruction and effective drainage of infected fluid/gas. For patients assortment and deciding suitable treatment modality Huang-Tseng CT Scan-based classification system was used.
Results: In our study mean age of the patients was 55.7 ±23 years with female predominance (2:1). Escherichia coli was commomest (67%) causative organism. Diabetes mellitus (95%) was commonest comorbidity found in our patients.
We found that causes of upper tract obstruction were ureteric calculi(22%), renal papillary necrosis(9%), ureteric stricture(6%), and fungal bezoar(3%) in the descending order of frequency. Total 31 patients were managed according to renal preserving protocol and only 1(3%) patient required salvage nephrectomy in this study. The median survival rate was 96%.
Conclusion: In our institutional study majority of patients with EPN were
having diabetes mellitus with female predominance. Most commonly isolated organism was E. coli, with majority of patients were having GRADE I or II (64%) EPN. These renal preserving strategies improved the overall survival rate as well as decreased the need for nephrectomy.
Impact Factor
2022: 6.012
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