EMPHYSEMATOUS PYELONEPHRITIS---A SEVEN YEAR EXPERIENCE

Introduction:

Emphysematous pyelonephritis (EPN) is necrotising infection which results in gas within the renal parenchyma, colleting system or perinephric tissue. Majority of cases occur in patients with diabetes mellitus. In EPN early aggressive medical treatment may avoid nephrectomy.

Methods:

 Retrospective analysis of 23 patients who presented with emphysematous pyelonephritis since 7 years (from 2017 to 2024) to the Nephrology Department at VPS Lakeshore Hospital and Research Center, Kochi was done. The presenting features, management strategies and prognosis have been analyzed.

Results:

23 patients were diagnosed with emphysematous pyelonephritis by plain CT abdomen. 60 % patients were above 60 years of age and 40% patients less than 60 years. Mean age is 58. Most of the patients were females around 13 of them . 8(34%) of them presented with class 1 EPN, 7 (30%) class2 EPN, 5(21%) class3 EPN, 3 (13%) class 4 EPN. All patients were having type2 DM, 6(26%) patients were having chronic kidney disease and 4(17%)of them were in stage 4 CKD ,two patients was on maintainence hemodialysis. All patients presented with fever and abdominal pain. 16% of them were in septic shock. 61% patients had AKI, 22% of patients had acute on chronic kidney disease, 22% patients were to undergo hemodialysis in view of severe renal failure excluding one patient who was already on MHD. 11% of them undergone CRRT and 50% undergone intermediate hemodialysis. EPN was limited to the left kidney in 10 patients , right kidney in 8 patients and was bilateral in 5 patients . 15 patients treated conservatively and 8 (34%) patients had to undergo surgical intervention- Surgical interventions done were RGP with DJ Stenting (4), PCNL with DGS (1), cystoscopy with DJ Stenting (1)and nephrectomy (2). Surgical intervention has improved renal function in all of the patients. . CT abdomen was the imaging technique used in all patients. Microbiological analysis was as follows: E coli( 55% of which one of them was ESBL), Klebsiella (16%of which 2 of them are CRE-XDR and 1 amp c), Candida nonalbicans (5%), Citrobacter koseri (5%). All patients were improved with parenteral antibiotics and antifungals for 14 days , surgical intervention and hemodialysis in selected patients, prophylaxis were not required in any of them. There were no mortality among these patients . 2 patients who were in stage 4 CKD became dialysis depended. There were no breakthough infections or further worsening of renal functions among these patients as of now.

Conclusions:

Despite being a life threatening illness , emphysematous pyelonephritis can be treated successfully if we diagnose early and give proper antibiotics according to the organism isolated and identify the patients who wants immediate hemodialysis and surgical intervention. We recommend early aggressive medical treatment, hemodialysis if required and post for elective surgical intervention in selected patients and can avoid nephrectomy.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.