Retrospective analysis of clinical profile prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis.
OBJECTIVE
We aimed to study the clinical profile, prognostic factors, and the 6-month outcome of patients with emphysematous pyelonephritis (EPN) METHODS: All patients admitted with a diagnosis of emphysematous pyelonephritis between January 2001 and July 2007 were included.


RESULTS
Overall 19 cases were diagnosed to have emphysematous pyelonephritis. There were 16 females and three males. Fourteen cases had type 2 diabetes mellitus. Fourteen cases had unilateral involvement and five had bilateral involvement. Eleven cases were classified as having class 1 or 2 disease and eight cases had class 3 and 4 disease. E. coli was the most common organism cultured (68.4%). Five cases underwent percutaneous drainage of the collecting system and three cases had nephrectomy of which 10.5% (two with advanced disease) expired. Shock at admission (p = 0.03), serum creatinine >5.0 mg/dl (p = 0.035) and DIC (p = 0.017) were independent poor prognostic factors. There was no difference in the prognosis between patients who had >or=2 or <2 poor prognostic factors (p = 0.16). However, prognosis was not related to disease class, unilateral vs. bilateral involvement, sepsis or the age of the patient. At 6 months, two patients were on maintenance hemodialysis.


CONCLUSIONS
In cases of EPN, shock, serum creatinine >5.0 mg/dl and DIC at admission are poor prognostic factors. Larger prospective studies are needed to confirm our findings.
Khaira
Ambar
A
Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, 110029, India. ambarkhaira@gmail.com
Gupta
Ankur
A
Rana
Devendra S
DS
Gupta
Ashwini
A
Bhalla
Anil
A
Khullar
Dinesh
D
D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis; D004322:Drainage / Q000379:methods; D004646:Emphysema / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests; D007710:Klebsiella Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011704:Pyelonephritis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D016482:Urinalysis
D000900:Anti-Bacterial Agents