title: [TREATMENT OUTCOME OF OBSTRUCTIVE PYELONEPHRITIS DUE TO URETERAL CALCULI WITH DISSEMINATED INTRAVASCULAR COAGULOPATHY].
abstract: OBJECTIVE
  Because obstructive pyelonephritis secondary to ureteral stones can easily cause sepsis and concomitant disseminated intravascular coagulation (DIC), it is a potentially lethal disease. However, the optimal treatment for such severe patients has yet to be established. In this study, we aimed at clarifying the effectiveness of emergent drainage and DIC treatments for patients with septic DIC due to obstructive pyelonephritis. In additon, we also evaluated the impact of recombinant human thrombomodullin (rTM) for severe patients with DIC.
  
  
  METHODS
  From September 2006 to May 2013, 31 patients with obstructive pyelonephritis secondary to ureteral stones who met the acute DIC criteria from the Japanese Association of Acute Medicine were treated at our institution. All patients received emergent drainage of urinary tract and anti-DIC treatment, as well as administration of antibiotics and adequate volume infusion. To evaluate the impact of rTM, patients received rTM were compared with those managed by other DIC therapeutic agents.
  
  
  RESULTS
  The mean patients' age was 73 years old, and 27 patients (87.1%) were in a state of septic shock. All patients, except for one patient (3.2%) who died 6 days after drainage, could recover from sepsis and comcomitant DIC. Interestingly, thrombocyte count, creatinine, and SOFA Score in rTM group were recovered faster than those in no rTM group (p = 0.017, 0.0038, and 0.0006, respectively).
  
  
  CONCLUSIONS
  These results indicate that most patients with DIC caused by obstractive pyelonephritis can be successfully managed by emergency drainage and anti-DIC treatment. In addition, rTM may be effective for the treatment of such severe patients by improving organ failure associated with disordered coagulation.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kubota
authors.forename: Toru
authors.initials: T
authors.lastname: Kanno
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Nishiyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Okada
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Higashi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamada
mesh_terms: D000368:Aged; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D011704:Pyelonephritis / Q000209:etiology; D018805:Sepsis / Q000209:etiology; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*