title: Kidney preservation protocol for management of emphysematous pyelonephritis: Treatment modalities and follow-up.
abstract: OBJECTIVE
  To present treatments for kidney preservation in the management of emphysematous pyelonephritis (EPN), and to evaluate the functional outcome of preserved kidneys during the follow-up.
  
  
  METHODS
  The computerized files of patients with EPN from 2000 to 2010 were reviewed. After initial resuscitation, ultrasonography-guided percutaneous tubes were placed for drainage of infected fluid and gas. A radio-isotopic renal scan was done after stabilization of the patients' condition. Preservation of the affected kidney was attempted when the differential function was >10%. A renal isotopic scan was taken during the follow-up to evaluate renographic changes in preserved kidneys.
  
  
  RESULTS
  The study included 33 kidneys in 30 consecutive patients (mean age 51.7 years, SD 10.9). Kidney preservation was applicable for 23 kidneys (20 patients). Preservation methods included percutaneous nephrostomy for 12, percutaneous tube drain for two and conservative treatment for nine kidneys (six patients). Nephrectomy was performed for 10 kidneys (emergency in three and delayed in seven). The frequency of post-treatment septic shock after kidney preservation (10%) was significantly lower than after nephrectomy (20%, P = 0.005). The overall mortality rate was 7% (two patients). The follow-up was completed for 13 patients with 15 preserved kidneys for a mean duration of 21 months. During the follow-up, differential renographic clearance of the affected kidney was stable in 13 of 15 while two kidneys showed improvement.
  
  
  CONCLUSIONS
  Kidney preservation should be the primary goal in the treatment of EPN when the differential renal clearance is >10%. It was associated with fewer complications than nephrectomy and the follow-up showed a favourable functional outcome of the preserved kidneys.
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: El-Nahas
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Shokeir
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Amogu Kalu
authors.initials: AK
authors.lastname: Eziyi
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Tamer S
authors.initials: TS
authors.lastname: Barakat
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Kehinde Habeeb
authors.initials: KH
authors.lastname: Tijani
authors.affiliation: Radiology Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: El-Diasty
authors.affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Hassan
authors.initials: H
authors.lastname: Abol-Enein
keywords: Diabetes mellitus; EPN, emphysematous pyelonephritis; Emphysematous pyelonephritis; Infection; NCCT, non-contrast CT; Obstruction; PCD, percutaneous tube drain; PCN, percutaneous nephrostomy; US, ultrasonography