A prospective study on the outcome of pyonephrosis and infected hydronephrosis drained by percutaneous nephrostomy -...

Pyonephrosis is defined as accumulation of purulent debris in the renal pelvis and urinary collecting system. Urinary diversion through percutaneous nephrostomy (PCN) is the first choice of treatment for pyonephrosis. Even after PCN insertion some patients end up with complete loss of renal function. We aim to determine the proportion of patients undergoing complete loss of renal function after PCN insertion, the factors facilitating renal function recoverability and the complications of the procedure.

In this prospective observational study, 100 patients with pyonephrosis were consecutively included over a period of one year. Pre-PCN and post-PCN creatinine clearance (CrCL) were analysed. Associated clinical factors were collected on a data sheet proforma. Data were analysed using Stata 12.1.

Mean age of study participants was 44.4 years (standard deviation: 11.8) where majority (69%) were males. Rate of nephrectomy after pyonephrosis was 15.6%. Among the participants, 77% patients did not have any complications after PCN insertion while 18% had dislodgement and 5% had bleeding. Significant improvement was found in post-PCN CrCL compared to pre-PCN CrCL (p-value: 0.001). Persons having severe hydronephrosis had lower odds of having improved glomerular filtration rate after PCN insertion (adjusted odd's ratio 0.3, p-value: 0.005, 95% confidence interval: 0.1-0.7) compared to those having moderate hydronephrosis.

Early PCN insertion is imperative for salvaging a pyonephrotic kidney. It is cost-effective and allows the patient to undergo definitive endourologic surgery for underlying pathology, thus avoiding a potential nephrectomy.