title: Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico.
abstract: OBJECTIVE
  To analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality.
  
  
  METHODS
  We retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality.
  
  
  RESULTS
  A total of 62 patients were included (49 women and 13 men), with a mean age of 53.9 years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (P=.06). Survivors were younger (P=.004), had lower creatinine (P=.002), and better estimated glomerular filtration rate (P=.007). In univariate analysis, age (P=.009), creatinine (P=.009), and need for nephrectomy (P=.03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, P=.03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, P=.049) remained significant predictors of mortality.
  
  
  CONCLUSIONS
  EPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.
authors.affiliation: Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México.
authors.forename: Daniel
authors.initials: D
authors.lastname: Olvera-Posada
authors.affiliation: Department of Urology, General Hospital of Mexico (HGM), Mexico City, México.
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Armengod-Fischer
authors.affiliation: Department of Urology, Social Security Institute of Mexican State and Municipalities (ISSEMyM), Estado de México, México.
authors.forename: Luis G
authors.initials: LG
authors.lastname: Vázquez-Lavista
authors.affiliation: Department of Urology, General Hospital of Mexico (HGM), Mexico City, México.
authors.forename: Miguel
authors.initials: M
authors.lastname: Maldonado-Ávila
authors.affiliation: Department of Urology, General Hospital of Mexico (HGM), Mexico City, México.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Rosas-Nava
authors.affiliation: Department of Urology, General Hospital of Mexico (HGM), Mexico City, México.
authors.forename: Hugo
authors.initials: H
authors.lastname: Manzanilla-García
authors.affiliation: Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Castillejos-Molina
authors.affiliation: Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Méndez-Probst
authors.affiliation: Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México.
authors.forename: Mariano
authors.initials: M
authors.lastname: Sotomayor
authors.affiliation: Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Feria-Bernal
authors.affiliation: Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México. Electronic address: frodriguez.covarrubias@gmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodríguez-Covarrubias
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents; D019090:Case Management; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D004646:Emphysema / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008800:Mexico; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods; D011704:Pyelonephritis / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents