Emphysematous pyelonephritis (EPN): A prospective study on management modalities and outcome in a tertiary care hospital

Abstract

Background: EPN was a rapidly progressive, fulminant, life threatening, necrotizing infection of kidneys and perinephric space. EPN was most commonly seen in patients with diabetes mellitus.Aim and Objective: To study the clinical features, radiological classification, risk factors, Prognostic factors and management Modalities of Emphysematous pyelonephritis. Methodology: 54 patients who were diagnosed to have Emphysematous pyelonephritis from various departments in Nizam’s institute of medical sciences from December 2016 to November 2019 were included in the study. The diagnosis of EPN was confirmed by plain CT KUB scan. Results: Of the 54 patients 16 were male and 38 were female. 40 patients with EPN had diabetes mellitus (DM). There was 4 patients who was diagnosed to have DM after admission. Left kidney involved in 51.80% (28) of patients. Right kidney in 37.03% (20) of cases. Out of 54 patients, 14 patients who were presented to us with EPN had a pre-existing CKD. Only 14 out of 54 patients with EPN had normal renal parameters. Thrombocytopenia was seen in 32 of these patients and 4 of patients with thrombocytopenia required platelet transfusion. Urine culture was sterile in 3 patients. E.coli was grown in 42 patients and klebsiella in 3patients. There were 14 patients with dry EPN and 40 patients with wet EPN. 21.8% (12) patients has class 1 EPN. 43.75% (24) of patients had Class 2 EPN (Commonest class in our study), 25% (13) of patients had class 3A EPN, 3.1% (2) had class 3B EPN, 6.25% (3) has Class 4 EPN. The mean follow up was 8 months, ranging from 3 months to 24 months. 40 patients are under regular follow up. Conclusion: Pre-existing CKD status, shock at presentation and altered sensorium are the poor prognostic factors in this study.