Emphysematous Pyelonephritis: Role and Factors Affecting Renal Conservation- ACross-sectional Study

Abstract

Introduction: Emphysematous Pyelonephritis (EPN) is a serious life threatening, necrotising infection which can affect renal parenchyma, collecting system and nearby tissue with presence of gas within renal system Aim: To check likelihood of kidney salvagibility by minimally invasive approaches in EPN and to see the prognostic factors that support kidney salvagibility in EPN. Materials and Methods: The cross-sectional study was conducted during October 2018 to June 2020 on 30 patients who were admitted in Department of Urology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha,India with features of EPN.Thirty patients with clinical and radio-logical features (Huang Tseng Classification) of EPN were enrolled in the study. All the biochemical parameters, clinical features and outcomes (patient who managed conservatively included in good outcome group while the patients who required nephrectomy were included in poor outcome group) continuous variables were analysed with the Unpaired t-test and categorical variables were analysed with fisher-exact test and multiple logistic regression test. Results were considered statistical significance when p-value was <0.05. Results: EPN was associated with diabetes mellitus in 80% of cases, 80% presented with complain of fever and loin pain was a presentation in 70% of cases. Mean serum Creatinine for good outcome was 1.4 and serum creatinine 2.5 or more was associated with poor outcome. Reduced platelet count (p-value=0.0143), altered mental status (p-value=0.0073), severe proteinuria (p-value=0 .0213), renal function impairment (p-value=0 .0493) and shock (p-value=0.0127) were statistically significant and associated with poor outcome. A 76% (n=21)cases were classified as good outcome group and 24% (n=9) cases classified as poor outcome group for which nephrectomy was done. Open nephrectomy was done in nine patients. Conclusion: There is a definite possibility of renal salvagibility by minimally invasive approaches in EPN in properly selected patients of EPN. Shock, altered mental status, raised serum creatinine, platelet count <120000/cmm, severe proteinuria are poor outcome factors which can lead to nephrectomy in conservatively managed cases of EPN.