Emphysematous pyelonephritis: A single center study

We present our experience of 22 cases of emphysematous pyelonephritis (EPN) treated from 1996 to 2012. Medical records were analyzed retrospectively for demographic profile, presence and duration of diabetes mellitus, and mode of clinical presentation. EPN was diagnosed based on demonstration of intra-renal gas by plain X-ray, ultrasound, and/or computed tomography (CT) scan. Details of medical treatment, reason for surgical intervention, and final outcome were recorded. Univariate analysis was performed to identify risk factors for mortality and P value of less than 0.05 was taken as significant. Twenty-two cases (6 males, 16 females) of EPN were diagnosed. Seven cases presented with acute pyelonephritis, seven cases with urosepsis, and the remaining eight patients with multi-organ dysfunction. CT grading of EPN was class IV in three, class III in four, class II in 14, and class I in one. All were initially managed medically with parenteral antibiotics. Ten patients needed additional surgical intervention. The overall survival rate was 86.3% (19/22). Among the risk factors analyzed higher CT grade, altered sensorium and thrombocytopenia were significantly associated with mortality. We conclude that a more conservative approach in managing EPN has become the standard of care. Patients having high CT grade of lesions (III and IV) with altered sensorium and thrombocytopenia at presentation are more likely to die due to the disease and may be better managed by an aggressive surgical plan.