April 2024, Volume 2, Issue 4

Author

Anil Kumar Nallabothula, Naveen Vulia Thillainathan, Praveen Kumar V, Sindhura Madugula, Sravan Reddy Pathakunta and Vignesh N C

Abstract

Background: Emphysematous pyelonephritis, a urological emergency, is characterized by an acute renal infection, associated with necrotic changes, due to gas-forming organisms. Though nephrectomy was considered as the traditional gold standard treatment, there is a change in the management due to improvement in outcomes with minimally invasive procedures like stenting and percutaneous drainage. Hence, in recent years, there is a notable shift towards this minimalistic approach, with or without need for nephrectomy. Methods: This is a retrospective observational study performed on patients who were treated in our hospital for EPN between October 2022 and March 2023. The poor prognostic factors assigned were altered mental status, shock on initial presentation, thrombocytopenia, Low albumin and need for emergency hemodialysis. Retrospective data including age, gender, comorbidities, imaging, laboratory investigations, necessity of emergency dialysis, treatment details and outcome was collected. The clinical predictors, treatment modalities employed and outcomes were analysed. Results: Thirty eight patients with EPN, from October 2022 to March 2023, were studied. Elderly patients were most commonly affected by EPN. All our patients were diabetic. We found that Klebsiella was involved in maximum number of cases followed by E. coli as the second most involved pathogen. In our study, the left kidney alone was involved in 44.7% of the patients and the opposite (right) kidney alone was involved in 36.8% individuals. Of our 38 patients, 34 (89.4%) had two or more unfavourable prognostic factors. 32 patients had high grade/extensive EPN, [class 3(73.4%) and class 4(11.8%)]. Conclusions: In our study of patients with EPN, elderly diabetic women were most commonly affected with Klebsiella being the most frequently isolated pathogen. Though two or more bad prognostic factors and along with extensive EPN (class 3/4) was seen in a large number of our patients, medical management with minimally invasive therapy provided a siginificant success rate of 94.7% with only few (2) patients succumbing and they were not fit for nephrectomy also. Hence, we support early aggressive medical and minimally invasive treatment and also, we suggest that major procedures like nephrectomy should be considered in patients only if they are not improving with minimally invasive treatment.