A clinical study of emphysematous pyelonephritis

Background: Emphysematous pyelonephritis should be suspected in every diabetic patient, presenting with features of acute pyelonephritis. E.coli is the most common organism associated with EPN. Aim: To study the clinical features, radiological classification and risk factors assess the prognostic factors and to study different management modalities of Emphysematous pyelonephritis and their outcomes. Materials and methods: It was prospective study done on 48 patients who were diagnosed to have Emphysematous pyelonephritis from various departments in Osmania General Hospital from October 2004 to October 2006 were included in the study. The diagnosis of EPN was confirmed by plain CT KUB scan. Results: All the 48 patients with EPN had diabetes mellitus (DM). All the 48 patients had poorly controlled DM. Left kidney was involved in 54.1% and Right kidney in 37.5% of cases. 6.25% of cases had bilateral involvement. Fever (93%) and tachycardia (64.5%) were most common presentation in patients. Thrombocytopenia was seen in 50% of these patients and 12% of patients with thrombocytopenia required platelet transfusion. Shock during initial presentation was seen in 22.9% of patients. 16.6% of patients presented with altered sensorium. E.coli was grown in 78% of patients and klebsiella in 6% of patients. There were 6 patients with dry EPN and 42 patients with wet EPN. 41.6% of patients had Class 2 EPN (Commonest class in our study), 25% of patients had class 3A EPN, 22.9% had Class 1 EPN, 6.25 had Class 4 EPN. 15.63% of patients were treated conservatively with antibiotics according to culture and sensitivity. 78% of patients required minimally invasive intervention. Nephrectomy was done in 6% of patients. Mortality rate in our study was 8.3%. Conclusions: Nephrectomy should be promptly attempted for patients not responding to conservative methods and patients with extensive, fulminant course of disease. Pre-existing CKD status, shock at presentation and altered sensorium are the poor prognostic factors in this study.