Emphysematous pyelonephritis: Retrospective analysis of 12 patients over a 2-year period

Midhun Ramesh, Ashutosh Mungi, Jayakrishnan Cherakkarakuzhiyil Peethambaran, Praveen Murlidharan, Satish Balan

Astrocyte 2016 3(2):114-117

Emphysematous pyelonephritis (EPN) is a life threatening infection of the renal parenchyma with gas formation, usually caused by the organism Escherichia coli and carries significantly high mortality rates. This study is a retrospective analysis of all cases of EPN admitted to our institute over a two year period. The clinical details, demographics, associations with co-morbid illnesses and urinary tract obstruction have been considered. The outcomes to treatment were assessed. Twelve patients of EPN were studied during the period of January 2013 to December 2014. The majority of them were females (male:female = 3:9) with a mean age of 51 years. Left sided EPN was more common than the right side. Three cases (25%) had bilateral EPN. Eleven patients were diabetics and ten cases had renal dysfunction. E. coli was the most common organism detected in urine culture and blood culture was sterile in most of the cases. Mean duration of hospital stay was 13 ± 4.86 days. The majority of patients responded to medical management and only one patient required unilateral nephrectomy. The literatures on EPN management suggest vigorous resuscitation and appropriate medical treatment, followed by immediate nephrectomy. However, with advancement of critical care nephrology, we conclude that aggressive management with appropriate antibiotics, strict diabetic control along with other supportive measures like renal replacement therapies will yield satisfactory results. Surgical intervention is required for urinary obstruction and nephrectomy should be reserved for the few patients who continue to deteriorate despite medical management and correction of obstruction.

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