Emphysematous pyelonephritis: Is nephrectomy warranted?

Abstract

Introduction:Emphysematous pyelonephritis (EPN) is associated with high mortality rate, up to 25%. There is still conflicting reports regarding the most appropriate management, conservative versus nephrectomy.Objective:To describe the outcome of patients with EPN.Methods:We retrospectively reviewed the medical records of patients diagnosed with EPN by computed tomography from three tertiary institutes in Jeddah, Saudi Arabia. Type of management was classified as conservative and surgical. The conservative includes medical and minimally invasive procedures, such as percutaneous drainage and nephrostomy. The surgical which is nephrectomy. The outcome observed was preservation of the kidney function or patient's life.Results:A total of 10 patients were included (9 females and 1 male), median age was 55 years and 63% were diabetic. The most common presentation was flank pain (100%), fever (75%), and vomiting (63%). The most common organism isolated was Escherichia coli. Nephrectomy was not associated with increased survival rate, while conservative management was associated with a good outcome, less morbidity (not dialysis-dependent).Conclusion:Nephrectomy was not associated with high survival rate. Patients managed conservatively had a better overall performance and better survival. This study will add to other studies, which are encouraging conservative management.

Clinical profile and successful outcomes of conservative and minimally invasive treatment of emphysematous pyelonephritis

“…In our patients, we observed that the bacteria were sensitive to piperacillin-tazobactam and meropenem in most patients, while they were resistant to gentamicin and levofloxacin in many patients. The success of conservative management has been reported in small case series and few case reports [ 21 – 25 ]. We found that PCD or DJ stenting, as the preferred initial treatment was helpful in our patients with EPN.…”

RE: Emphysematous pyelonephritis: Is nephrectomy warranted?

“…We read with great interest the article “Emphysematous pyelonephritis: Is nephrectomy warranted?” by Alsharif et al . [ 1 ] This article highlights interesting updates in managing emphysematous pyelonephritis (EPN) from radical surgery to medical management. Similar finding was published earlier by Ubee et al .…”

“…The results clearly shown that both patients who undergo early nephrectomy had lower hemoglobin (Hb) level (7.1 and 7.4 g/dl), whereas others had Hb range between 9.1 and 13.1 mg/dl. [ 1 ] As Hb levels usually determine the chronicity of the disease, there was a possibility that both patients had late detection. Besides that, there were three patients developed septic shock in this series.…”

“…The patient who had medical management had active tuberculosis on treatment, and the other one had multiple comorbidities include diabetes mellitus, hypertension, ischemic heart disease, liver cirrhosis, and hypothyroidism. [ 1 ] Whereas the patient who survived after septic shock was younger (55-year-old) and has less medical illness (only diabetes mellitus and hypertension). [ 1 ] In our opinion, these showed that the mortality in this series was much related to late detection and multiple comorbidities rather than treatment option.…”

“…[ 1 ] Whereas the patient who survived after septic shock was younger (55-year-old) and has less medical illness (only diabetes mellitus and hypertension). [ 1 ] In our opinion, these showed that the mortality in this series was much related to late detection and multiple comorbidities rather than treatment option. Those patients were immune compromise at presentation.…”