Diagnostic performance of pre-management computed tomography findings as a predictor of conservative treatment success in patients with emphysematous pyelonephritis

Abstract

Background Emphysematous pyelonephritis (EPN) is one of the most serious urologic emergency which should be diagnosed and treated adequately to prevent impending septic shock and death. Computed tomography (CT) is the gold standard radiologic modality for diagnosis, grading and predicting the outcome. We aimed in this study to define the initial CT radiological findings correlated with EPN conservative management success. Results This study involved 54 patients (42 women and 12 males) with a mean age of 48 ± 10 years. EPN grades I, II, III, and IV were noticed in 12, 17, 20, and 5 patients, respectively. Ten patients (18.5%) received successful conservative management. On the other hand, renal drainage was needed in 42 patients (77.8%). Delayed nephrectomy was required in two cases (3.7%). In univariate and multivariate analyses, the absence of hydronephrosis and decreased air locules volume were predictors of conservative treatment success (P = 0.003 and 0.01, respectively). Conclusions Conservative therapy should be selected in certain patients of emphysematous pyelonephritis. Decreased air locules volume and the absence of hydronephrosis in pre-admission computed tomography were predictors for conservative therapy success.

A Rare Case of Emphysematous Pyelonephritis in a Non-diabetic Patient With Staghorn Calculus

“…CT findings play a pivotal role in guiding the therapeutic approach for EPN [ 11 ]. When functional kidney tissue is present, the initial treatment typically involves the administration of antibiotics, fluid resuscitation to restore hydration, and management of blood sugar levels, particularly in diabetic patients.…”

A case series on emphysematous pyelonephritis of north Kerala: Case series and review of literature

“…Perinephric and intraparenchymal fluid accumulation are seen on MRI. [19,20] On the basis of radiological findings on CT scan jj huang et al classified EPN into 4 classes, Huang and Tseng staging protocols: [7]  Class 1: Gas in the collecting system  Class 2: Gas restricted to renal parenchyma  Class 3A: Perinephric gas or abscess extension  Class 3B: Gas extension beyond the Gerota's fascia  Class 4: Bilateral or single-kidney EPN…”

“…A study done by MA Badaway et al over 16 years from 2000 to 2016 in 54 patients found that the presence of air locule volume >54 cc and hydronephrosis were associated with 12 and 5.5 folds of risk of failure of conservative treatment (7).…”

Is JJ Ureteral Stenting Inferior to Percutaneous Nephrostomy as a Drainage Method in Emphysematous Pyelonephritis?

“…Estimated GFR (eGFR) in mL/min/1.73 m 2 was calculated using EPI-CKD formula [9]. Radiological evaluation by noncontrast computed tomography was reviewed for the presence of distal obstruction, grades of EPN [lower grades (I, II) and high grades (III, IV)] [3], and air locule volume in mm 3 [8,10]. Available follow-up renography data were also reviewed.…”