Affiliation:
1. Department of Urology, Institute of Post Graduate Medical Education and Research & Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
Abstract
Abstract
Introduction:
The management of emphysematous pyelonephritis (EPN), a necrotizing renal infection, has shifted from more invasive to less invasive approach in due course of time with decrease or reduction in mortality rate.
Aim:
To analyze the clinical spectrum, prognostic factors, different management strategies, and the outcome of the patients of EPN with the role of early pigtail drainage.
Materials and Methods:
The study was carried out at a tertiary care hospital from January 2016 to December 2021 and included patients who were diagnosed with EPN. The data on the demographic profile, clinical features, biochemical parameters, imaging studies, management, and outcome of patients of EPN were recorded.
Results:
A total of 51 patients of EPN were studied and were divided into two groups, responders (40 patients) and nonresponders (11 patients), based on their clinical progression and outcome. Among responders and nonresponders, a significant difference was seen in terms of age, presentation of altered consciousness and shock, average hemoglobin, average serum creatinine, and presence of thrombocytopenia. Out of total 51 patients, 13 (25.49%) showed a response with antibiotics only, DJ stenting was done in five (9.8%) patients, and pigtail catheterization in 33(64.7%) patients. There was a significant difference seen in the response with early pigtail drainage. Nephrectomy was needed in eight (15.68%) patients, and the mortality rate was 9.8%, with the death of five patients.
Conclusion:
Advanced age, lower hemoglobin levels, thrombocytopenia, raised serum creatinine levels, altered mental status, and presence of shock can be used as a score for poor prognosis. With the use of broad-spectrum antibiotics and early pigtail drainage, a large number of patients with EPN can be managed effectively. Nephrectomy should be reserved for patients who fail to respond to conservative management or those with advanced disease with the presence of multiple risk factors.