Emphysematous Pyelonephritis: Does a Standard Management Algorithm and a Prognostic Scoring Model Optimize Patient Outcomes?

Overview

Journal Urol Ann

Specialty Urology

Date 2019 Oct 26

PMID 31649464

Citations 18

Authors

Amit Jain

Ramanitharan Manikandan

Lalgudi Narayanan Dorairajan

Sreerag Kodakkattil Sreenivasan

Sriharsha Bokka

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of the study is to analyze the risk factors determining the outcomes of patients with emphysematous pyelonephritis (EPN) by the adoption of a standardized management algorithm as well as to develop a prognostic scoring model to risk stratify these patients.

Materials And Methods: The hospital records of 72 consecutive patients with EPN from February 2012 to January 2018 were retrospectively reviewed. Demographic, clinicoradiographic, and laboratory characteristics were recorded. Patients were managed with a standard management protocol and based on outcomes divided into three groups. Group I survived with conservative management, Group II survived after emergency nephrectomy, and Group III expired. The risk factors for nephrectomy and mortality were analyzed.

Results: The mean age was 53 years. Male to female ratio was 4:5. There were 61 (84.7%), 4 (5.6%), and 7 (10%) patients in Groups I, II, and III, respectively. Diabetes mellitus was the most common comorbidity detected in 62 (86%) of patients. Type II EPN was the most common radiological presentation observed in 32 (44%) patients. Overall survival rate was 90%, and kidney salvage rate was 80%. was the most common organism isolated. Thirty-two (45%) patients exhibited resistance to third-generation cephalosporin antibiotics. Thrombocytopenia, low body mass index (BMI), presence of >2 comorbidities, high total leukocyte count (TLC), and hypoalbuminemia were significantly associated with mortality. On adoption of the prognostic scoring system, mortality rates according to the risk subgroups were as follows: favorable - 0%, intermediate - 19%, and poor - 100%.

Conclusion: Conservative management adopting appropriate algorithm reduces mortality and avoids unnecessary emergency nephrectomies. Thrombocytopenia, low BMI, presence of >2 comorbidities, high TLC, and hypoalbuminemia were significantly associated with mortality.

Citing Articles

Clinical image: emphysematous pyelonephritis.

Rotter L, Lee B, Golden M Oxf Med Case Reports. 2024; 2024(12):omad156.

PMID: 39664917 PMC: 11631207. DOI: 10.1093/omcr/omad156.

Radiology and Non-operative Management of Emphysematous Infections of the Pancreas, Gallbladder, and Urinary System.

Persaud S, Deyalsingh S, Ramsingh K, Barrow T Cureus. 2024; 16(10):e70955.

PMID: 39507128 PMC: 11540101. DOI: 10.7759/cureus.70955.

Scoring System to Personalize Management of Emphysematous Pyelonephritis.

Mittal A, Kumar D, Panwar V, Ranjan R, Navriya S, Upadhyaya A Urol Res Pract. 2024; 50(3):193-197.

PMID: 39499022 PMC: 11562922. DOI: 10.5152/tud.2024.23165.

Emphysematous Pyelonephritis in Cancer Patients: A Case Report With a Literature Review.

Singh K, Greene J Cureus. 2024; 16(7):e65000.

PMID: 39161488 PMC: 11333016. DOI: 10.7759/cureus.65000.

Non-albicans Candida Infection as a Rare Cause of Emphysematous Pyelonephritis in an Uncontrolled Diabetic Patient: A Case Report.

Chaudhari P, Sawant R, Bordoloi M, Kumar S, Acharya S Cureus. 2024; 16(3):e57036.

PMID: 38681271 PMC: 11046370. DOI: 10.7759/cureus.57036.

References

Michaeli J, Mogle P, Perlberg S, Heiman S, Caine M . Emphysematous pyelonephritis. J Urol. 1984; 131(2):203-8. DOI: 10.1016/s0022-5347(17)50309-2. View

Olvera-Posada D, Armengod-Fischer G, Vazquez-Lavista L, Maldonado-Avila M, Rosas-Nava E, Manzanilla-Garcia H . Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico. Urology. 2014; 83(6):1280-4. DOI: 10.1016/j.urology.2014.02.010. View

Klein F, Smith M, Vick 3rd C, Schneider V . Emphysematous pyelonephritis: diagnosis and treatment. South Med J. 1986; 79(1):41-6. DOI: 10.1097/00007611-198601000-00013. View

Lin Y, Lin Y, Lin H, Lin L . Risk factors of renal failure and severe complications in patients with emphysematous pyelonephritis-a single-center 15-year experience. Am J Med Sci. 2011; 343(3):186-91. DOI: 10.1097/MAJ.0b013e318225b891. View

Huang J, Chen K, Ruaan M . Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection. J Urol. 1991; 146(1):148-51. DOI: 10.1016/s0022-5347(17)37736-4. View

Huang J, Tseng C . Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000; 160(6):797-805. DOI: 10.1001/archinte.160.6.797. View

Al-Goblan A, Al-Alfi M, Khan M . Mechanism linking diabetes mellitus and obesity. Diabetes Metab Syndr Obes. 2014; 7:587-91. PMC: 4259868. DOI: 10.2147/DMSO.S67400. View

SCHULTZ Jr E, KLORFEIN E . Emphysematous pyelonephritis. J Urol. 1962; 87:762-6. DOI: 10.1016/S0022-5347(17)65043-2. View

Touiti D, Deligne E, Badet L, Colombel M, Martin X, Gelet A . [Emphysematous pyelonephritis: report of 3 cases]. Prog Urol. 2002; 11(4):703-6. View

10.

El-Nahas A, Shokeir A, Eziyi A, Barakat T, Tijani K, El-Diasty T . Kidney preservation protocol for management of emphysematous pyelonephritis: Treatment modalities and follow-up. Arab J Urol. 2015; 9(3):185-9. PMC: 4150599. DOI: 10.1016/j.aju.2011.09.002. View

11.

Sokhal A, Kumar M, Purkait B, Jhanwar A, Singh K, Bansal A . Emphysematous pyelonephritis: Changing trend of clinical spectrum, pathogenesis, management and outcome. Turk J Urol. 2017; 43(2):202-209. PMC: 5503442. DOI: 10.5152/tud.2016.14227. View

12.

Lu Y, Hong J, Chiang B, Pong Y, Hsueh P, Huang C . Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis: 51 Cases and 14-Year-Experience of a Tertiary Referral Center. Medicine (Baltimore). 2016; 95(21):e3573. PMC: 4902344. DOI: 10.1097/MD.0000000000003573. View

13.

Kapoor R, Muruganandham K, Gulia A, Singla M, Agrawal S, Mandhani A . Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis. BJU Int. 2009; 105(7):986-9. DOI: 10.1111/j.1464-410X.2009.08930.x. View

14.

Frey C, Zhou H, Harvey D, White R . Co-morbidity is a strong predictor of early death and multi-organ system failure among patients with acute pancreatitis. J Gastrointest Surg. 2007; 11(6):733-42. DOI: 10.1007/s11605-007-0164-5. View

15.

Pontin A, Barnes R . Current management of emphysematous pyelonephritis. Nat Rev Urol. 2009; 6(5):272-9. DOI: 10.1038/nrurol.2009.51. View

16.

Lau S, Peng M, Chang F . Resistance rates to commonly used antimicrobials among pathogens of both bacteremic and non-bacteremic community-acquired urinary tract infection. J Microbiol Immunol Infect. 2004; 37(3):185-91. View

17.

Ubee S, McGlynn L, Fordham M . Emphysematous pyelonephritis. BJU Int. 2010; 107(9):1474-8. DOI: 10.1111/j.1464-410X.2010.09660.x. View

18.

Falagas M, Alexiou V, Giannopoulou K, Siempos I . Risk factors for mortality in patients with emphysematous pyelonephritis: a meta-analysis. J Urol. 2007; 178(3 Pt 1):880-5. DOI: 10.1016/j.juro.2007.05.017. View

19.

Ramachandran A, Snehalatha C, Shyamala P, Vijay V, Viswanathan M . High prevalence of NIDDM and IGT in an elderly south Indian population with low rates of obesity. Diabetes Care. 1994; 17(10):1190-2. DOI: 10.2337/diacare.17.10.1190. View

20.

Somani B, Nabi G, Thorpe P, Hussey J, Cook J, Ndow J . Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008; 179(5):1844-9. DOI: 10.1016/j.juro.2008.01.019. View