title: Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis.
abstract: OBJECTIVE
  To analyse the factors predicting the mortality and need for nephrectomy in patients with emphysematous pyelonephritis (EPN).
  
  
  METHODS
  Clinical features, laboratory variables, imaging studies, management strategy and the final outcomes were analysed in 39 consecutive patients with EPN. The mean (sd) age was 57 (7.2) years and the male to female ratio was 2:11. The baseline risk factors (clinical, laboratory and radiological) were compared among three groups; group 1, survived with renal salvage (26); group 2, survived after nephrectomy (eight); and group 3, died (five).
  
  
  RESULTS
  The overall survival rate was 87% (34/39) and the kidney was salvaged in 67% (26) patients at a median follow-up of 18 months. Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation were significantly associated with mortality rate. There was no significant difference in final outcome based on radiological classification. Extensive renal parenchymal destruction of >50% (based on computed tomography) significantly predicted the need for nephrectomy (P < 0.001) and death (P = 0.02). Early (<1 week) nephrectomy resulted in a higher mortality rate (three of seven patients) than initial conservative management. There were no deaths in selected patients who received antibiotics alone or had delayed nephrectomy (four patients each). Of 24 patients who had minimally invasive treatment alone, two (8%) died. Minimally invasive treatment resulted in high renal salvage (22/24, 92%).
  
  
  CONCLUSIONS
  Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation are associated with higher mortality rates, whereas extensive renal parenchymal destruction is associated with a need for nephrectomy. Early nephrectomy is associated with higher mortality rates than is initial conservative management.
authors.affiliation: Sanjay Gandhi Post Graduate Institute, Lucknow, India. rkapoor@sgpgi.ac.in
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kapoor
authors.forename: Kaliyaperumal
authors.initials: K
authors.lastname: Muruganandham
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Gulia
authors.forename: Manish
authors.initials: M
authors.lastname: Singla
authors.forename: Saurabh
authors.initials: S
authors.lastname: Agrawal
authors.forename: Anil
authors.initials: A
authors.lastname: Mandhani
authors.forename: M S
authors.initials: MS
authors.lastname: Ansari
authors.forename: Aneesh
authors.initials: A
authors.lastname: Srivastava
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004646:Emphysema / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000628:therapy*; D004927:Escherichia coli Infections / Q000150:complications / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D011704:Pyelonephritis / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents