MO650EMPHYSEMATOUS PYELONEPHRITIS IN TYPE 2 DIABETES – CLINICAL PROFILE AND MANAGEMENT

Abstract

Abstract Background and Aims Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on management of EPN. Method A prospective observational study was conducted at Department of General Surgery at RML institute of Medical sciences , Lucknow as well as at Eras Lucknow medical college, Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis. Results A total of 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). The mean age of the patients was 58.4±6.5 years. Mean duration of diabetes was 5.3 ± 3.3 years. 12 (82%) of the 15 patients with DM had a glycosylated hemoglobin A1C level higher than 7.5. Renal dysfunction at presentation was seen in 11 (73.3%) patients. Among the unilateral involvement, left kidney was more affected. Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively. Of 15 EPN patients, 13 (86.6 %) survived and 1 (6.6 %) expired. 2 of them underwent nephrectomy both survived. All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation and thrombocytopenia were associated with poor outcome in EPN patients (P < 0.05) Multiple logistic regression tests showed shock (P = .04) and and disturbance of consciousness (P = .05) on hospital admission as being the independent factors for poor outcome. Conclusion EPN in diabetics needs high index of suspicion, timely diagnosis and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes.