[The characteristics of the treatment procedure in acute suppurative pyelonephritis in diabetic patients]

From 1986 to 1992 the authors treated 160 patients with acute purulent pyelonephritis (APP) associated with diabetes mellitus (DM). 100 patients were diagnosed to have diffuse-purulent pyelonephritis (DPP), 60 patients (37.5%) had purulent-destructive pyelonephritis (PDP). The authors carried on two different surgical policies: in 1986-1988 a conservative approach was followed (7 out of 21 patients underwent nephrectomy, 14 underwent nephrostomy and other organ-sparing operations), in 1989-1992 a radical approach was used. After the nephrostomy there were 7 lethal outcomes (53.8%) and 6 cures. Histological examination of the kidneys from the latter patients revealed DPP with major renal pelvic involvement. Lethal outcomes were caused by intoxication resultant from progressive purulent destruction in the operated on kidney in the presence of uncorrectable hyperglycemia with ketoacidosis. In view of mutual aggravation observed in APP and DM and ineffectiveness of nephrostomy in PDP, indications to radical removal of the inflammation focus (nephrectomy) are of vital character. This explains why the conservative approach was changed for the radical one according to which nephrectomy was conducted in 37 (94.8%) of the surgical patients. Lethal outcomes of nephrectomy under the radical approach reached 27%. The employment of active radical policy reduced postoperative lethality by 26.8%. It is inferred that in DPP conservative methods including nephrostomy are valid. IN PDP primary nephrectomy in justified. Overall positive results were achieved in 80% of the patients. A 20% lethality was due to severe DM, APP form and imperfect therapeutic policy.