Emphysematous pyelonephritis: Our experience with conservative management in 14 cases.
BACKGROUND
Emphysematous pyelonephritis (EPN) is a rare, severe, acute, necrotizing infection of the kidney. In this study, we present the clinical details, the management strategies, and the outcome of fourteen patients of EPN managed at our center.


METHODS
A retrospective analysis of the hospital records was done. A total of fourteen patients with EPN were admitted in our hospital from August 2007 to February 2011. All the patients were managed conservatively. Follow-up ranged from six months to one year.


RESULTS
Of the fourteen patients, four belonged to class I, five to class II, four to class IIIA and one to class IIIB. All the patients had history of fever, 43% had localized flank pain while 36% had vague abdominal discomfort. Renal angle tenderness was the most common sign, seen in 86% of the patients. E. coli was the most common bacteria, which was isolated from urine in 57% of the patients. On the risk factor stratification, three patients had simultaneous presence of 2 or more risk factors (thrombocytopenia-2 patients; renal function impairment-7 patients; shock-1 patient). All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad spectrum antibiotics. Intervention, in the form of percutaneous drainage or DJ stenting, was done in six patients. One patient failed to respond to this minimally invasive modality of treatment and had to undergo an open drainage. Thus, the acute episode was managed with conservative management strategies in all the patients; however, three patients underwent nephrectomy due to poorly-functioning kidney during follow-up.


CONCLUSIONS
EPN is now being more readily diagnosed, at an early stage, making conservative management of EPN a safe, effective, and feasible option.
Department of Urology, Institute of Post Graduate Medical Education and Research, SSKM Hospital, Kolkata, India.
Pramod Kumar
PK
Sharma
Ritu
R
Sharma
Mukesh K
MK
Vijay
Punit
P
Tiwari
Amit
A
Goel
Anup K
AK
Kundu
Emphysematous pyelonephritis; nephrectomy; renal infection