Introduction:
Emphysematous pyelonephritis (EPN) is a life-threatening necrotising infection of the kidneys. There have been limited published reports of this condition in literature. We share our experience of 46 patients with emphysematous pyelonephritis presenting as acute kidney injury (AKI)/ acute on chronic kidney disease ( acute on CKD), their outcomes and prognostic factors.
Methods:
From 1 August 2023 to 31 July 2024, we performed a prospective study of 46 patients with emphysematous pyelonephritis presenting with AKI/ Acute on CKD admitted in our hospital. Patients who had EPN diagnosis confirmed with non -contrast computed tomography presented with renal failure were included in the study. Demographic, clinical, laboratory, radiological parameters, details of treatment, urological procedures and final outcomes were recorded. Patients were divided into 3 groups, group 1(n=21) – patients survived with conservative treatment, group 2(n=19)- patients survived with urological intervention, group 3(n=6) -patients who expired. Prognostic scoring was devised based on significant variables obtained by univariate analysis and risk stratification was done.
Results:
Data from 46 patients were analysed. 92% of our study population had diabetes mellitus. Females were more commonly affected than males. The incidence of acute on CKD was higher than AKI. E. coli (37.2%) being the most common organism isolated from the urine culture. Higher incidence of class 2 EPN (45.7%) based on Huang-Tseng CT classification system. 54.30% were treated conservatively. 46% required minimally invasive interventions. 26% required renal replacement therapy. Mortality rate in our study was 13%. 6 significant variables were identified associated with prognosis in each of the three groups. Hb<8, low serum sodium, raised SGOT levels, presence of class 4 EPN, need for ventilatory support, longer duration of comorbid illness (p value<0.05) were significantly associated with mortality.
Conclusions:
EPN outcomes can be improved by multidisciplinary approach, early diagnosis, identifying prognostic factors, risk assessment and initiating early treatment. This approach would make EPN a condition with less morbidity and mortality.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.