Are there any predictors of pyonephrosis in patients with renal calculus disease?
The objective of the study is to identify factors predicting development of pyonephrosis in patients of renal calculus disease (RCD), as this knowledge is largely unknown. Patients of RCD without pyonephrosis (Group 1) or with pyonephrosis (Group 2) presenting between December 2013 and November 2015 were evaluated. All patients of RCD who had undergone either percutaneous nephrostomy (PCN) or surgical management (percutaneous nephrolithotomy/pyelolithotomy/nephrectomy) were included. Patients treated conservatively, by extracorporeal shock-wave lithotripsy and patients of bilateral RCD were excluded. Data regarding demography, co-morbidities, associated urologic disease, previous intervention, clinical presentation, urinary culture, renal function, grade of hydronephrosis, stone characteristics were collected. 501 patients were included (Group 1: 410; Group 2: 91). Mean age in years (35.02 versus 35.48), sex ratio (2.12:1 versus 2.25:1) and mean body mass index (kg/m2) (22.27 versus 22.15) were similar in both groups. Prevalence of diabetes mellitus (3.41% versus 3.29%, p = 1.000) was similar. Group 2 patients had longer duration of symptoms (5.77 versus 8.96 months, p < 0.0001), associated urological diseases such as ipsilateral PUJO and ureteric calculus (4.63% versus 12.08%, p = 0.0125), moderate/severe-grade hydronephrosis (49.75% versus 92.30%, p < 0.0001), presence of staghorn calculus (20.73% versus 62.63%, p < 0.0001), multiple calculi (48.29% versus 68.13% p = 0.0007) and nonfunctioning kidney (1.70% versus 71.42%, p < 0.0001) as predictors of pyonephrosis. In logistic multivariate analysis, additionally, past history of urological surgery (p = 0.044) was found associated with pyonephrosis. Our study identified some conditions associated with patients of pyonephrosis. To prove their role as risk factors we recommend further studies.
Department of Urology, King George's Medical University, Lucknow, 226003, UP, India.
Madhusudan
M
Patodia
Department of Urology, King George's Medical University, Lucknow, 226003, UP, India. drapul.goel@gmail.com.
Apul
A
Goel
Department of Urology, King George's Medical University, Lucknow, 226003, UP, India.
Vishwajeet
V
Singh
Department of Urology, King George's Medical University, Lucknow, 226003, UP, India.
Bhupendra Pal
BP
Singh
Department of Urology, King George's Medical University, Lucknow, 226003, UP, India.
Rahul Janak
RJ
Sinha
Department of Urology, King George's Medical University, Lucknow, 226003, UP, India.
Manoj
M
Kumar
Department of Urology, King George's Medical University, Lucknow, 226003, UP, India.
Divakar
D
Dalela
Department of Urology, King George's Medical University, Lucknow, 226003, UP, India.
Satya Narayan
SN
Sankhwar
D058186:Acute Kidney Injury; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000150:complications / Q000151:congenital* / Q000453:epidemiology / Q000601:surgery; D007668:Kidney / Q000473:pathology / Q000601:surgery; D007669:Kidney Calculi / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D021782:Multicystic Dysplastic Kidney / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D009392:Nephrectomy; D000074642:Nephrolithotomy, Percutaneous; D009403:Nephrostomy, Percutaneous; D015995:Prevalence; D053018:Pyonephrosis / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D000069856:Staghorn Calculi; D013997:Time Factors; D014514:Ureteral Calculi / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D014517:Ureteral Obstruction / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D055815:Young Adult
Infected hydronephrosis; Predictors of pyonephrosis; Pyonephrosis; Renal calculus disease; Renal stone; Staghorn calculi