MP29-19 NOVEL SCORING SYSTEM AND ADVANCED MANAGEMENT ALGORITHM FOR EMPHYSEMATOUS PYELONEPHRITIS

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II (MP29)1 Sep 2021MP29-19 NOVEL SCORING SYSTEM AND ADVANCED MANAGEMENT ALGORITHM FOR EMPHYSEMATOUS PYELONEPHRITIS Rohit Ranjan, Ankur Mittal, Vikas Panwar, Navriya Shivcharan, Shanky Singh, and Arup Kumar Mandal Rohit RanjanRohit Ranjan More articles by this author , Ankur MittalAnkur Mittal More articles by this author , Vikas PanwarVikas Panwar More articles by this author , Navriya ShivcharanNavriya Shivcharan More articles by this author , Shanky SinghShanky Singh More articles by this author , and Arup Kumar MandalArup Kumar Mandal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002026.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Emphysematous pyelonephritis (EPN) is an acute severe necrotizing infection which results in gas within the pelvicalyceal system, renal parenchyma, or perinephric tissue. It has very high rate of nephrectomy and mortality up to 40-50%. Early aggressive medical treatment and diversion of system may avoid nephrectomy. In this study, we analysed the characteristics of patients with EPN with respect to their demography, clinical presentation, radiological image, microbiological findings, treatment modality and their outcome. We also introduce an EPN scoring system to classify the patient for internal or external diversion. METHODS: In this retrospective study we have included 40 consecutive patients coming to our tertiary care hospital and diagnosed to have EPN, from June 2018 to December 2020. Diversion of pelvicalyceal system was done, either internal (DJ stent) or external (percutaneous nephrostomy, PCN). RESULTS: Mean age was 55.8 years with 4.9 days of mean duration of illness. 90.6% patients were in sepsis and 46.9% in shock. Most commonly isolated organism was E. coli (68.8%) & antibiogram was Piperacillin Tazobactam (71.9%). 66.7% patients had higher grade EPN (3 or 4). Most common cause was renal stone (65.6%) followed by diabetes (56.3%). DJS was done in 24 patients (60%) and was sufficient for 17 patients (70.8%) and 2 expired (8.3%). PCN was done 16 patients (40%) and was sufficient in 14 patients (87.5%) and 2 expired (12.5%). So total 35 patients (87.5%) were treated successfully just by diversion (internal or external) and nephrectomy was circumvented. We identified certain risk factors and gave score (1-3) to each, based on their weightage in prognosis, like- Age >45 years, Haemoglobin <9 gm/dL, S. Creatinine >3 mg/dL, Mean Arterial Pressure <65 mm Hg, Presentation and diagnosis >72 hours, High grade of EPN (3 or 4), Subcutaneous emphysema or collection and Complication of other system. We calculated EPN score of all the patients retrospectively and 15 patients had score of 7 or less, success rate was 100% for both, DJS (15/15) and PCN (4/4); whereas 25 patients had score of more than 7, success rate was 83.3% (10/12) for PCN and 22.2% (2/9) for DJS. CONCLUSIONS: With availability of wide range of antibiotics along with timely intervention in the form of internal or external diversion is effective and curative in 87.5% patients. If EPN score is 7 or less then internal diversion (DJ stent) and if its more than 7 then external diversion (PCN) should be preferred. Nephrectomy can be considered only if patients deteriorate or do not improve on conservative treatment after diversion. Source of Funding: Nil © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e498-e498 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohit Ranjan More articles by this author Ankur Mittal More articles by this author Vikas Panwar More articles by this author Navriya Shivcharan More articles by this author Shanky Singh More articles by this author Arup Kumar Mandal More articles by this author Expand All Advertisement Loading ...