Prognostic factors determining outcome in Emphysematous Pyelonephritis – A Tertiary Care Centre Experience at Goa Medical College

Abstract

Abstract :

Introduction & objective:

Emphysematous pyelonephritis (EPN) is an acute necrotising parenchymal and perirenal infection caused by gas forming organisms commonly occurring in diabetic patients. A discreet evaluation of these patients for specific prognostic factors is extremely important. Objective was to study impact of individual prognostic factors on need for nephrectomy and outcome with regards to mortality in these patients.

Methods:

147 cases of EPN were prospectively studied at Goa Medical College between April 2008 and March 2022. Their mode of presentation, co-morbid conditions, severity of sepsis and 5 prognostic factors (altered sensorium, shock, acidosis, thrombocytopenia and need for dialysis) were analysed. All cases initially underwent DJ stenting/ percutaneous nephrostomy/ percutaneous drain insertion.

Results:

All patients were found to be diabetic. 96 patients had acidosis on presentation, 75 patients presented in shock and 45 in altered sensorium. 66 patients had obstructed system. 30 patients underwent nephrectomy and overall mortality was 17%. Among four prognostic factors found statistically significant, altered sensorium followed by acidosis had the highest Odd’s ratio with maximum impact on the outcome of patients (logistic regression test).

Conclusion:

Among 5 prognostic factors studied, presence of altered sensorium followed by acidosis was found to have maximum impact on the need for nephrectomy and mortality.

In cases of emphysematous pyelonephritis the need for nephrectomy after minimally invasive intervention depends not only on the class of emphysematous pyelonephritis but also on general condition of patient and involvement of other systems in the cascade of sepsis.