SP125EMPHYSEMATOUS PYELONEPHRITIS : A RETROSPECTIVE OBSERVATIONAL STUDY TO PREDICT THE FACTORS ASSOCIATED WITH SEVERITY AND MANAGEMENT STRATEGIES

Abstract

BACKGROUND: Emphysematous pyelonephritis (ePN) is a severe; necrotizing renal parenchymal infection that is characterized by the production of intraparenchymal gas. It carries a much higher mortality than conventional cases of pyelonephritis. High-dose antibiotic therapy alone or with percutaneous drainage in contrast to bilateral nephrectomy may be a preferable approach to salvage kidney function. AIM OF THE STUDY: To study the clinical profile of EPN; To analyse factors predicting the severity of EPN; To correlate severity with management strategies and outcome. METHODS: Hospital records are reviewed from Jan 2012 to June 2017. Demographic data; clinical features; laboratory parameters; imaging; treatment and outcomes are analysed. Huang and Tseng CT grading was used to grade severity into 4 types namely type 1; gas in the collecting system only; type 2; gas in the renal parenchyma without extension to extrarenal space; type 3; extension of gas or abscess to perinephric space (3A) or pararenal space (3B); and type 4: bilateral EPN or solitary kidney with EPN. Type 1 and 2 formed less severe group (Group 1) and Type 3a; 3b; 4 formed severe group (Group 2). Differences between the groups were analysed using the unpaired t test for continuous variables and chi-square for categorical variables; with P < 0.05 considered statistically significant. RESULTS: Of the 30 patients diagnosed; mean age is 51.5±14.7. Male to female ratio 1.1:1 diabetes seen in 76%; renal stone disease in 33%; congenital anamoles in 6%. Mean HBA1c in group 1 is 6.6±1.2; in group 2 is 7.68±1.2 suggesting poor glycemic control in severe grade. At admission; symptoms included fever (93%); flank pain (96%); nausea/vomiting (63%); dysuria (73%); altered sensorium (16%); oliguria (33%). Mean serum albumin in group 1 is 3.04±0.47; in group 2 is 2.36±0.4. Urine culture shows positive growth in 43% out of which Ecoli seen in 77%. Medical management alone given in 26%; RRT support given in 43%; DJ stenting done in 23%; PCNL in 52%. Dialysis dependent in 15%. CONCLUSIONS: In EPN; presence of low serum albumin is associated with severity; blood culture and urine culture positivity seen in 17% and 43% with Ecoli being common organism identified. Medical treatment along with DJ stenting and PCN in severe EPN is able to salvage kidney.