Emphysematous pyelonephritis: Clinical characteristics and prognostic factors

Abstract

Abbreviations & AcronymsObjectives: Emphysematous pyelonephritis is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens. The aim of the present study was to determine the clinical characteristics and prognostic factors of patients with emphysematous pyelonephritis. Methods: We retrospectively analyzed the clinical and laboratory data, imaging findings, and outcomes of 32 patients with emphysematous pyelonephritis. Receiver operating characteristic curve analysis was carried out on variables that were significantly associated with patient mortality. Results: The overall survival rate was 87.5% (28/32). Escherichia coli (43.6%) was the most common organism cultured from urine and blood specimens. Hypoalbuminemia, shock as the presenting feature, bacteremia, need for hemodialysis and polymicrobial infection were significantly more common in cases resulting in death. The area under the receiver operating characteristic curve was 0.96. The cut-off point determined by the maximum Youden index (0.93) for three of these five factors yielded a sensitivity of 1.00 and specificity of 0.93. Shock as an initial presentation (P = 0.039) and polymicrobial infection (P = 0.010) were significantly associated with poor outcome. There were no significant differences in the clinical or laboratory features of the patients who did or did not undergo nephrectomy. Conclusion: Hypoalbuminemia, shock as an initial presentation, bacteremia, indications for hemodialysis and polymicrobial infection represent prognostic factors for mortality in patients with emphysematous pyelonephritis. Patients presenting with more than two of these prognostic factors carry the highest risk of mortality, and they require timely diagnosis and aggressive management.

Risk of SOFA Deterioration in Conservative Treatment for Emphysematous Pyelonephritis: Pitfalls of Current Trends in Therapeutics from Multicenter Clinical Experience

“…An increase in the SOFA score ≥ 2 points is associated with an in-hospital mortality rate > 10% [21]. Risk factors for EPN mortality were documented by numerous researchers: thrombocytopenia [6,9,10,13], shock [6,12,13], altered sensorium [6,13], and acute renal impairment/hemodialysis [6,10,12,13]. These risk factors are associated with septic complications, and partly constitute the SOFA score.…”

“…These risk factors are associated with septic complications, and partly constitute the SOFA score. Hypoalbuminemia [12], bacteremia [12], polymicrobial infection [12], conservative treatment [9], Wan's Type I EPN [9], and bilateral EPN [9] were also reported as prognostic factors.…”

“…Over the last 25 years, the overall mortality rate of EPN has greatly improved to 12.5-25% thanks to advances in the early diagnosis and critical management of this life-threatening condition with antibiotics, fluid hydration, oxygen, acid-base balance correction, multi-organ support, and percutaneous catheter drainage (PCD) of the affected kidney(s) [7,9,11,12,13]. Special attention has been paid to the therapeutic efficacy of PCD because it offers a lower mortality rate than medical management alone or emergency nephrectomy [7,11].…”

“…Furthermore, numerous investigators demonstrated that risk factors for mortality due to EPN are thrombocy-topenia, shock, altered status of consciousness, and acute impairment of renal function/need for hemodialysis [6,9,10,12,13,17]. Each of the risk factors is commonly incorporated into the Sequential Organ Failure Assessment (SOFA), the score of which grades functional abnormality of organ systems and accounts for clinical interventions and sepsis-related mortality [21].…”

Emphysematous pyelonephritis

“…Emphysematous pyelonephritis is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is life-threatening, and requires aggressive diagnosis and treatment [1]. The CT scan is the best imaging modality for early diagnosis.…”