Reappraisal of the management and outcome of emphysematous pyelonephritis.
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.
Lin
Wei-Ching
WC
Department of Radiology, China Medical University Hospital, Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan.
Chen
Yung-Fang
YF
Lin
Chien-Heng
CH
Ho
Yung-Jen
YJ
Tzeng
Yuan-Hong
YH
Chiang
Hsein-Jar
HJ
Chang
Chao-Hsiang
CH
Cheng
Yi-Chang
YC
Shen
Wu-Chung
WC
Chen
Jeon-Hor
JH
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