Deriving a management algorithm for emphysematous pyelonephritis: Can we rely on minimally invasive strategies or should we be opting for earlier nephrectomy?

Abstract:

PURPOSE:To analyse the incidence and management of emphysematous pyelonephritis (EPN) in North West London and examine factors that influence immediate and 6-month outcomes with the aim of guiding future management. METHODS:This work analyses EPN cases from the London North West Healthcare NHS Trust from October 2006 to July 2015 (population ≈ 850,000). Diagnosis and stage were confirmed by computed tomography (CT). Demographic, clinical, biochemical and microbiological characteristics were assessed. Treatment modalities were medical management, minimally invasive management (MIM) and surgical. Immediate and 6-month outcomes were analysed. RESULTS:Thirteen cases were identified (f = 8, m = 5) from 5525 CT scans. EPN occurred in patients with diabetes mellitus (n = 11, 84.6%), hypertension (n = 10, 76.9%) or urinary tract calculi (n = 7, 53.85%). Unilateral EPN occurred predominantly (n = 11, 84.6%); 46.1% (n = 6) were class 1 or 2 and 53.8% (n = 7) class 3 or 4. Escherichia coli was most commonly cultured (n = 5, 38.46%). All patients received antibiotics, and ten cases required MIM. Two patients had a delayed nephrectomy, both survived. Mortality was 15.4% (n = 2, grade 1 and 3a), both died acutely post-MIM, neither underwent emergency nephrectomy. At 6 months, eight patients had ongoing renal impairment. No specific poor prognostic factors were identifiable. CONCLUSIONS:Patients with low-grade EPN may also have a high mortality rate. In the two cases who died, earlier consideration for nephrectomy may have been prudent. It may be beneficial to have a low threshold for prompt emergency nephrectomy in severe cases and where MIM treatment has failed. We suggest a management algorithm to guide clinicians and minimise mortality.

journal_name

Int Urol Nephrol

authors

Boakes E,Batura D

doi

10.1007/s11255-017-1706-8

subject

Has Abstract

pub_date

2017-12-01 00:00:00

pages

2127-2136

issue

12

eissn

0301-1623

issn

1573-2584

pii

10.1007/s11255-017-1706-8

journal_volume

49

pub_type

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