title: Reappraisal of the management and outcome of emphysematous pyelonephritis.
abstract: This study compared the management, prognostic factors and outcomes of patients with emphysematous pyelonephritis (EPN). Twenty-one patients with EPN were studied between September 1996 and August 2005, and were assigned to two groups. Patients in Group 1 received conservative treatment with/without percutaneous catheter drainage (PCD) while patients in Group 2 underwent nephrectomy following medical treatment and PCD. A post hoc analysis of the prognostic factors was performed between survivors and nonsurvivors, and between the survivors in Group 1 and Group 2. There were 14 patients in Group 1, and seven in Group 2. The mortality in Group 1 was 35.7% (5/14) and in Group 2 was 0% (p = 0.12). There were no statistically significant differences in prognostic factors between the two groups, though patients in Group 1 had relatively lower platelet counts (p = 0.07) and Group 2 patients had a higher incidence of dialysis after nephrectomy (p = 0.03). Comparing the survivors and nonsurvivors, patients with comorbid congestive heart failure and patients initially presenting with consciousness disturbances had higher mortalities (p = 0.02 and p < 0.01, respectively). Nonsurvivors also had lower platelet counts (p = 0.06). In conclusion, medical treatment with/without PCD can be used to manage patients with EPN. More agressive drainage is needed in patients with congestive heart failure who initially present with consciousness disturbances or thrombocytopenia.
authors.affiliation: Department of Radiology, China Medical University Hospital, Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan.
authors.forename: Wei-Ching
authors.initials: WC
authors.lastname: Lin
authors.forename: Yung-Fang
authors.initials: YF
authors.lastname: Chen
authors.forename: Chien-Heng
authors.initials: CH
authors.lastname: Lin
authors.forename: Yung-Jen
authors.initials: YJ
authors.lastname: Ho
authors.forename: Yuan-Hong
authors.initials: YH
authors.lastname: Tzeng
authors.forename: Hsein-Jar
authors.initials: HJ
authors.lastname: Chiang
authors.forename: Chao-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.forename: Yi-Chang
authors.initials: YC
authors.lastname: Cheng
authors.forename: Wu-Chung
authors.initials: WC
authors.lastname: Shen
authors.forename: Jeon-Hor
authors.initials: JH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D004646:Emphysema / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011704:Pyelonephritis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011859:Radiography; D016896:Treatment Outcome