Emphysematous Pyelonephritis -Pattern Of Clinical Presentation And Outcome: Single Center Study
Journal Title: Stanley Medical Journal - Year 2016, Vol 3, Issue 4
Abstract
Context: Emphysematous pyelonephritis(EPN) is a life threatening necrotizing infection of the kidney. It is commonly seen in diabetic patients and continues to be a major cause for morbidity and mortality. Treatment options were limited in the past and most patients were managed surgically. With newer antibiotic protocols medical management is effective in most of the cases. The objective of this study is to elucidate the clinical features, radiological classification and outcome of EPN including response to pure medical therapy. Aims: Elucidate the clinical features, radiological classification,outcome and risk factors for mortality of EPN Methods and Material: Study population included patients with urinary tract infection(Proven by culture) and radiological evidence of Gas in the collecting system ,renal parenchyma or perirenal tissue. Twenty four patients with EPN who were admitted in our hospital from August 2012 to September 2016 were included in this prospective observational study. The clinical presentation,co -morbidities , baseline laboratory data and abdominal CT scan were taken. Patients were classified into four stages based on CT imaging.All the patients were started on medical management with antibiotics .Those patients not responded to medical therapy were offered surgical treatment and the outcome of management was assessed. Results: Mean age of the study group was 50.04 13.7 years. .Fever was the most common presenting symptom. Diabetes was the most important predisposing factor(87.5%).Shock at admission was present in 16.7% of patients. E.coli was the most common organism isolated from urine(75%).Patients were divided in to different classes based on CT imaging and most of them belonged to Class II.Most of the patients managed successfully with antibiotics and only 8.3% of patients required surgical intervention.Multiple factors found to influence the mortality such as shock,altered sensorium ,thrombocytopenia,hyponatremia and advanced classes in CT scan Conclusions: Medical therapy is the corner stone of management of class I and classII EPN.For advanced classes of EPN ,a combination of medical and surgical approaches may be warranted and tailored to the need of individual patients
Authors and Affiliations
MohanDas M. K. , Sajeev Kumar K. S. , Hareesh K. G, Rakesh. S. Nair
Keywords
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