title: Emphysematous pyelonephritis: Is nephrectomy warranted?
abstract: BACKGROUND
  Emphysematous pyelonephritis (EPN) is associated with high mortality rate, up to 25%. There is still conflicting reports regarding the most appropriate management, conservative versus nephrectomy.
  
  
  OBJECTIVE
  To describe the outcome of patients with EPN.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients diagnosed with EPN by computed tomography from three tertiary institutes in Jeddah, Saudi Arabia. Type of management was classified as conservative and surgical. The conservative includes medical and minimally invasive procedures, such as percutaneous drainage and nephrostomy. The surgical which is nephrectomy. The outcome observed was preservation of the kidney function or patient's life.
  
  
  RESULTS
  A total of 10 patients were included (9 females and 1 male), median age was 55 years and 63% were diabetic. The most common presentation was flank pain (100%), fever (75%), and vomiting (63%). The most common organism isolated was Escherichia coli. Nephrectomy was not associated with increased survival rate, while conservative management was associated with a good outcome, less morbidity (not dialysis-dependent).
  
  
  CONCLUSIONS
  Nephrectomy was not associated with high survival rate. Patients managed conservatively had a better overall performance and better survival. This study will add to other studies, which are encouraging conservative management.
authors.affiliation: Research Promotion and Education Section, King Abdullah International Research Center, Jeddah, Saudi Arabia.
authors.forename: Mada
authors.initials: M
authors.lastname: Alsharif
authors.affiliation: Research Promotion and Education Section, King Abdullah International Research Center, Jeddah, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Mohammedkhalil
authors.affiliation: Research Promotion and Education Section, King Abdullah International Research Center, Jeddah, Saudi Arabia ; Department of Surgery, Urology Section, King Khalid National Guard Hospital, King Abdulaziz Medical City, Saudi Arabia ; Department of Surgery, Urology Section, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, Jeddah, Saudi Arabia.
authors.forename: Basim
authors.initials: B
authors.lastname: Alsaywid
authors.affiliation: Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia.
authors.forename: Ali
authors.initials: A
authors.lastname: Alhazmy
authors.affiliation: Department of Surgery, Urology Section, King Khalid National Guard Hospital, King Abdulaziz Medical City, Saudi Arabia ; Department of Surgery, Urology Section, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, Jeddah, Saudi Arabia.
authors.forename: Salahadin
authors.initials: S
authors.lastname: Lamy
keywords: Diabetes mellitus; emphysematous pyelonephritis; nephrectomy; percutaneous drainage