Clinical profiles and outcomes of emphysematous pyelonephritis: A single center experience

Abstract

Introduction: Emphysematous pyelonephritis (EPN) is a severe and life-threatening necrotising infection of the kidney characterised by the presence of gas in the parenchymal tissue. The mortality rate for EPN is as high as 25%. We present the retrospective analysis of clinical profiles and Outcomes of a series of patients with EPN who were managed either, medically or with early Double J stenting (DJ) between June 2016 and January 2019 at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences And Research Foundation. Methods: The clinical and laboratory data, imaging findings, and microbiological patterns of 15 patients and their medical management, between June 2016 and January 2019 at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation chosen for the study were recorded. Results: The mean age of the study group patients was 56.6±6.2 years (range 43–74 years). There were nine females (60.3%) and six males (39.7%). Symptoms were abdominal pain (80%), fever (73.3%), dysuria (73.3%). 86.6% of the patients had diabetes. The most common microbial pathogen organism cultured was Escherichia coli (71.42%). Patients who had minimal gas on CT scan which was restricted to the collecting system (stage I Huang and Tseng class) received medical treatment only. Pateints with grade 2,3 and 4 eventually required DJ stenting as there was no clinical improvement after 48 hours of medical and supportive management.Conclusion:Medical management and early minimally invasive drainage procedures form the main stay in the management of EPN cases. In today’s era, the role of radical procedures like nephrectomy in EPN is minimal. Among the drainage procedure, DJ stenting in our study showed a good outcome. As DJ stenting can be done under regional/local anesthesia and has less morbidity for the patient, it was preferred over PCN.