Contemporary Mortality and Comparative Outcomes of Nephrectomy Versus Non-nephrectomy Management in Emphysematous
Okelue E Okobi1,2, Annelise Fernandez3, Emasenyie Isikwei1
1Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA.
Cureus
|May 4, 2026
Summary
Emphysematous pyelonephritis (EP) management has evolved. This review found contemporary EP mortality is lower and non-nephrectomy approaches significantly reduce mortality compared to nephrectomy.
Area of Science:
- Nephrology
- Infectious Diseases
- Surgical Oncology
Background:
- Emphysematous pyelonephritis (EP) is a severe necrotizing kidney infection with high mortality.
- Optimal management strategies for EP remain debated despite advances in imaging and minimally invasive treatments.
Purpose of the Study:
- To systematically review and meta-analyze contemporary mortality rates associated with Emphysematous pyelonephritis.
- To compare patient outcomes between non-nephrectomy management and nephrectomy for EP.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched peer-reviewed literature (2010-2025) for adult EP studies reporting mortality.
- Pooled mortality data using random-effects modeling and compared management strategies via odds ratios (ORs).
Main Results:
- Included 26 studies for qualitative synthesis and 11 studies (523 patients) for meta-analysis.
- Pooled mortality for EP was 7.7% (95% CI, 4.4-13.3) with moderate heterogeneity.
- Non-nephrectomy management was associated with significantly lower odds of mortality compared to nephrectomy.
Conclusions:
- Contemporary mortality for Emphysematous pyelonephritis is lower than previously reported.
- A selective, stepwise management approach, prioritizing non-nephrectomy interventions, is supported by current evidence.
- Findings suggest non-nephrectomy management improves survival outcomes in EP patients.
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