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EMPHYSEMATOUS PYELONEPHRITIS : A RETROSPECTIVE OBSERVATIONAL STUDY TO PREDICT THE FACTORS ASSOCIATED WITH SEVERITY AND MANAGEMENT STRATEGIES Free

INTRODUCTION AND AIMS: Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal parenchymal infection that is characterized by the production of gas in the collecting system, renal parenchyma, perinephric tissue. · The first observation was done by Kelly and Maccallum1 in 1898 ,they used the term pneumaturia, later the term EPN was made by Schultz and Klorfein in 1962· It carries a much higher mortality than conventional cases of pyelonephritis · High-dose antibiotic therapy alone or with percutaneous drainage in contrast to bilateral nephrectomy may be a preferable approach to salvage kidney function.This retrospective study the clinical profile and analyze the factors predicting the severity of Emphysematous pyelonephritis

METHODS: The hospital records of diagnosed emphysematous pyelonephritis patients were reviewed retrospectively over the past 5 years from January 2012 to June 2017 and demographic data, clinical features, risk factors, laboratory parameters ,imaging, treatment and outcomes were analyzed. · The associated co morbidities such as Diabetes and hypertension and their correlation with the disease were noted. · The diagnosis was confirmed by Non Contrast Computer Tomography scan and Huang and Tseng CT grading was used to grade the severity into 4 types (4) · Type 1 and 2 formed less severe group (Group 1) and Type 3a; 3b; 4 formed more severe group (Group 2). · All the patients were managed by diabetic and hypertensive control, maintenance of hemodynamic stability, empirical antibiotics to start with which were subsequently modified depending on the blood and the culture sensitivity reports. Φυνγαλ ινϕεχτιον χαυσινγ ΕΠΝ αρε εξχλυδεδ · The analyses of outcome variables with continuous data were done as mean (with standard deviation). Comparison of various outcomes between the two groups with categorial data was done using two-sample unpaired t-test (parametric test) with p value < 0.05 considered statistically significant.

RESULTS: : Out of the 30 patients diagnosed with EPN, 16 were males and 14 were females (M:F:1.1:1) with the mean age of 51.5±14.7. 76%were diabetics with mean HbA1c in group 1 is 6.6±1.2, in group 2 is 7.68±1.2 . The presenting complaints included fever in 93%.Five patients (16%) presented with altered sensorium . Mean serum albumin in group 1 is 3.04±0.47and in group 2 is 2.36±0.4 (p value 0.007).All patients had underwent Non contrast CT abdomen which was 100% diagnostic. Ecoli was the most common organism isolated . In group 1, the mean HSCRP was 88.70 ±51.5 and mean procalcitonin was 9.3±10.1. In group 2, the mean HSCRP was 113.71±41 and mean procalcitonin was 18.89±29.Medical management alone was given in (26%) patients. 13 (43%) patients required RRT support of which 11 patients are free of dialysis at the time of discharge. 52% patients required PCNL. Severe pyonephrosis with nonfunctioning kidney warranted nephrectomy in two patients

CONCLUSIONS: In EPN, presence of low serum albumin and higher Hba1c are associated with severity. Most common organism associated with EPN is E.coli. Medical treatment along with DJ stenting and PCN in severe EPN can salvage the kidney. Higher values of Hscrp and Procalcitonin are seen in severe group however they are not statistically Significant. Major limitation of this study is the sample size