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Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico.

Abstract：

OBJECTIVE:To analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality. METHODS:We retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality. RESULTS:A total of 62 patients were included (49 women and 13 men), with a mean age of 53.9 years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (P=.06). Survivors were younger (P=.004), had lower creatinine (P=.002), and better estimated glomerular filtration rate (P=.007). In univariate analysis, age (P=.009), creatinine (P=.009), and need for nephrectomy (P=.03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, P=.03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, P=.049) remained significant predictors of mortality. CONCLUSION:EPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.

journal_name

Urology

journal_title

Urology

authors

Olvera-Posada D,Armengod-Fischer G,Vázquez-Lavista LG,Maldonado-Ávila M,Rosas-Nava E,Manzanilla-García H,Castillejos-Molina RA,Méndez-Probst CE,Sotomayor M,Feria-Bernal G,Rodríguez-Covarrubias F

doi

10.1016/j.urology.2014.02.010

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

1280-4

issue

6

eissn

0090-4295

issn

1527-9995

pii

S0090-4295(14)00139-3

journal_volume

83

pub_type

杂志文章,多中心研究

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