Acute pyelonephritis: A single-center experience

Abstract

Acute pyelonephritis (APN), although a common clinical entity, still not much is known about the clinical profile in the Indian scenario. We prospectively collected clinical, biochemical, and radiological data of patients hospitalized with a diagnosis of APN from March 2014 to June 2016. A total of 296 cases were included in the study. Mean age was 53.85 ± 9.78 years. Male to females ratio was 1.93:1. Among the risk factors recognized for complicated pyelonephritis (PN), diabetes mellitus (DM) (54.4%) was the most common factor followed by renal calculi (14.4%), benign prostatic hyperplasia (6.7%), immunocompromised state (3.3%), stricture urethra and meatal stenosis (3.3%), and neurogenic bladder (2%). Urinary culture was negative in 153 (51.7%) and positive in 143 patient (48.3%). Most common organism isolated was Escherichia coli (29.7%), followed by Klebsiella pneumoniae (5.4%), pseudomonas (5.4%), Enterococcus (4.4%), and Proteus in 10 (3.4%). Serum creatinine of more than 1.5 mg/dl at admission was seen in 96.3% patients; 40% of them had underlying chronic kidney disease with DM being the most common. Multiorgan dysfunction either at admission or during the course in hospital stay was seen in 31.8% patients. Twelve (2%) had emphysematous PN. Six patients had Class II, 4 had Class III, 1 with Class I, and another with Class IV. A total of 18 deaths were noted (6.1%). Hemoglobin <10 g/dl, serum creatinine at admission >1.5 mg/dl, HbA1c% >10%, and immunosuppression had statistically significant association with the development of multiorgan dysfunction on univariate analysis, but on multivariate analysis, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance. Even with attributable risk of mortality, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance on multivariate analysis. HbA1c% adds to the predictive parameters to recognize at-risk patients to intensify the treatment and avoid complications.

Pathological and radiological irregularities in patients with chronic kidney disease - An observational study

“…Mean BUN 113.57±29.158 ranging within 34-229. This results were consistent with Umesha et al, 11 and Tambo et al 8 Mean serum albumin in patients was 2.67±0.551 mg/dl; serum globulin was 3.89±0.345 mg/dl while total protein was 6.02±0.651 mg/dl. A/G ratio was 1.528±0.6632.…”

Bilateral Pneumonia and Emphysematous Pyelonephritis as an Inaugural Presentation of Diabetes: A Case Report and Review of Literature

“…It has a tendency to affect more females than males and the majority of cases, up to 95%, are associated with underlying uncontrolled diabetes mellitus, which was not only described in known cases of diabetes but also as de novo presentations of long-standing diabetes. Obstruction of the urinary collecting system may also be an underlying cause [1][2][3]. Pathogens that have been implicated in EP are most commonly Escherichia coli (~67% of cases), K. pneumoniae (~20% of cases), Proteus mirabilis, and coagulase-negative Staphylococcus [1,3,4,6].…”

“…EP is a rare, potentially life-threatening necrotizing infection of the renal parenchyma and surrounding tissue with characteristic gas formation. It is associated with a high mortality rate due to sepsis and associated multi-organ dysfunction if left untreated [ 1 , 2 , 5 ]. It has a tendency to affect more females than males and the majority of cases, up to 95%, are associated with underlying uncontrolled diabetes mellitus, which was not only described in known cases of diabetes but also as de novo presentations of long-standing diabetes.…”

“…Emphysematous Pyelonephritis (EP) is a rare, life-threatening infection that can rapidly lead to renal parenchymal necrosis, acute deterioration of renal function, and septic shock [ 1 , 2 ]. It usually occurs in a particular subset of patients with either uncontrolled diabetes mellitus or immunocompromised status and requires prompt diagnosis, urgent resuscitation, and timely intervention [ 1 , 3 , 4 ].…”

Etiological Characteristic of Microbial Causative Agents of Inflammatory Diseases of Kidneys and Urinary Tract Infection in Children Depending on Age and Gender

“…В наш час проблема бактеріальних інфекцій нирок та сечових шляхів у дітей, незважаючи на широкий спектр антибактеріальних препаратів, все ще залишається актуальною. Найпоширенішим захворюванням є пієлонефрит, що являє собою мікробно-запальне захворювання нирок з переважним вогнищевим інфекційно-запальним ушкодженням тубулоінтерстиційної тканини, яке пов'язане з інфекцією сечових шляхів, що потрапляє в нирки гематогенним, лімфогенним чи висхідним шляхом [1]. За даними багатьох дослідників встановлено, що етіологічним фактором гострих та хронічних пієлонефритів у більшості випадків є монофлора та провідними мікроорганізмамизбудниками пієлонефритів у дітей були визначені E. coli, E. faecalis, K. рneumoniae, Proteus spp., Pseudomonas aeruginosa [2,3].…”