title: Role of Conservative Management in Emphysematous Pyelonephritis - A Retrospective Study.
abstract: BACKGROUND
  Emphysematous pyelophritis (EPN) is a serious condition with significant mortality. The prognosis of patients with EPN has changed over the years. Mortality has declined with prompt and aggressive medical management and minimally invasive strategies.
  
  
  OBJECTIVE
  To identify the prognostic factors and assess the outcome of conservative management of emphysematous pyelonephritis.
  
  
  METHODS
  This was a retrospective study of 8 consecutive patients who were diagnosed with EPN in two medical institutes between July 2010 and June 2015.
  
  
  METHODS
  Eight consecutive patients diagnosed with emphysematous pyelonephritis between July 2010 and June 2015 was studied retrospectively. On the basis of Computerised tomographic scan findings they were grouped into four classes (1 to 4) according the modified classification recommended by Huang and Tseng. The management was conservative (combination of percutaneous drainage and antibiotics), immediate nephrectomy or delayed nephrectomy (when conservative management failed). Demographic, clinical, biochemical and radiological characteristics were assessed and compared between survivors and nonsurvivors.
  
  
  RESULTS
  Seven (87.5%) of a total of 8 patients had diabetes mellitus. Escherichia coli (71.4 %) was the most common offending pathogen identified in pus culture. With conservative management in 7 patients (combination of percutaneous drainage and antibiotics), treatment was successful in 57.14 % and with immediate nephrectomy (one patient), the success rate was 100%. The risk factors for mortality were thrombocytopenia, shock and altered sensorium at presentation. The mortality rate in class 1, 2 and 3 was 0%, 33.3% and 66.7%. None of the patient had class 4 EPN.
  
  
  CONCLUSIONS
  A combination of percutaneous drainage with antibiotics offers an effective therapy for emphysematous pyelonephritis.
authors.affiliation: Assistant Professor, Department of Urology, JNIMS , Imphal, India .
authors.forename: Sholay Meitei
authors.initials: SM
authors.lastname: Kangjam
authors.affiliation: Assistant Professor, Department of Paediatric Surgery, RIMS , Imphal, India .
authors.forename: Keshorjit Singh
authors.initials: KS
authors.lastname: Irom
authors.affiliation: Senior Resident, Department of Surgery, JNIMS , Imphal, India .
authors.forename: Ibomcha Singh
authors.initials: IS
authors.lastname: Khumallambam
authors.affiliation: Professor, Department of Urology, RIMS , Imphal, India .
authors.forename: Rajendra Singh
authors.initials: RS
authors.lastname: Sinam
keywords: Percutaneous drainage; Perinephric tissue; Risk factors; Upper urinary tract