English

Abstract

BACKGROUND: Emphysematous pyelonephritis (EPN) is a rare, severe, acute, necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens. AIMS AND OBJECTIVES: To present our experience and discuss the various management approaches for treating Emphysematous pyelonephritis. MATERIALS AND METHODS: A retrospective analysis of the hospital records was done. A total of thirty two patients with EPN were admitted in our hospital from October 2011 to November 2013. All the patients were managed conservatively. Follow-up ranged from three months to two years. RESULTS: Of the thirty two patients, seven belonged to class I, fourteen to class II, eight to class IIIA, one to class IIIB and two to the class IV. Thirty patients had history of fever, 24 had localized flank pain while 7 had dysuria, 8 had hypotension and 6 patients presented with altered sensorium. E. coli was the most common bacteria, which was isolated from urine in 78% of the patients. On the risk factor stratification, twelve patients had simultaneous presence of 2 or more risk factors (thrombocytopenia-19 patients; renal function impairment-29 patients; shock-8 patient; altered sensorium-6). All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad spectrum antibiotics. Intervention, in the form of percutaneous drainage or DJ stenting, was done in Twenty five patients. Thus, the acute episode was managed with conservative and minimally invasive management strategies in all the patients; however, two patients of class IIIA underwent nephrectomy because of their delayed presentation and due to not recovering from sepsis in spite of percutaneous drainage. CONCLUSIONS: EPN is now being more readily diagnosed, at an early stage, making conservative and minimally invasive management of EPN a safe, effective, and feasible option.