Factores pronósticos en pielonefritis enfisematosa

Olvera‐Posada, Daniel; García-Mora, Arturo; Culebro-García, Carolina; Castillejos-Molina, R.A.; Sotomayor, Mariano; Feria-Bernal, Guillermo; Rodríguez-Covarrubias, Francisco

doi:10.1016/j.acuro.2012.03.021

Cited by 15 publications

(13 citation statements)

References 15 publications

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“…1 ). Full reports were evaluated in 48 studies, of which 32 were included in the systematic review [1–3,6–8,10–21,24–37] . Most of the studies were published within the last 10 years, reflecting the increased awareness of EPN and the associated controversy.…”

Section: Resultsmentioning

confidence: 99%

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Emphysematous pyelonephritis: Time for a management plan with an evidence-based approach

Aboumarzouk

Hughes

Narahari

et al. 2014

Arab Journal of Urology

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IntroductionEmphysematous pyelonephritis (EPN) is a life-threatening necrotising kidney infection, but there is no consensus on the best management.MethodsWe systematically reviewed previous articles published from 1980 to 2013 that included studies reporting on EPN, and applying the Cochrane guidelines, we conducted a meta-analysis of the results.ResultsIn all, 32 studies were included, with results for 628 patients (mean age 56.6 years, range 33.8–79.9). There were 462 women, outnumbering men by 3:1. Diabetes was present in 85% of the cases. Fevers and rigor (74.7%), pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was associated with 54.4% of deaths while obstructive uropathy was associated with 15.1% of deaths. Computed tomography was diagnostic in all the cases. Percutaneous drainage (PCD) and medical management (MM) alone were associated with a significantly lower mortality rate than was emergency nephrectomy (EN), with an odds ratio (95% confidence interval) for PCD vs. EN of 3.13 (1.89–5.16; P < 0.001), for EN vs. MM of 2.84 (1.62–4.99; P = 0.001), and of 0.91 (0.53–1.56; P = 0.73, i.e., no difference) for PCD vs. MM. Open drainage also had a significantly lower mortality rate than EN, with a ratio of 0.12 (0.02–0.91; P < 0.04).ConclusionThe overall mortality rate was ≈18%; shock was associated with a high mortality rate and therefore should be managed aggressively. PCD and MM were associated with significantly higher survival rates than EN, and therefore EN should only be considered if the patient does not improve despite other treatments.

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Section: Resultsmentioning

confidence: 99%

“…To aid in the decision, a few reports have been published with mortality rates stratified by risk variables, delineating which patients need more aggressive management than others [10,12–16] . However, these were not only based on relatively few patients, but between the studies they also had varying results for the same risk variable.…”

Section: Introductionmentioning

confidence: 99%

Emphysematous pyelonephritis: Time for a management plan with an evidence-based approach

Aboumarzouk

Hughes

Narahari

et al. 2014

Arab Journal of Urology

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“…Por otro lado, se ha descrito ampliamente que la existencia de sepsis, sepsis grave y shock séptico determinan cifras significativamente superiores de PCT 11,13 , hecho que confirman nuestros resultados y que podrían hacer que se pudiera incorporar a la PCT como otro factor de predictor de pielonefritis enfisematosa junto con la comorbilidad, alteración del nivel de consciencia, leucocitosis y disfunción multiorgá-nica, como señalaron Olveda-Posada et al 28 , donde el 67% de los pacientes con pielonefritis enfisematosa presentaban sepsis grave y el 11% shock séptico.…”

Section: Discussionunclassified

Utilidad de la procalcitonina y proteína C reactiva para predecir bacteriemia en las infecciones del tracto urinario en el servicio de urgencias

Julián-Jiménez

Gutiérrez-Martín

Lizcano-Lizcano

et al. 2015

Actas Urológicas Españolas

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“…Factors predisposing to EPN are diabetes mellitus, found in as much as 94.3% of cases, age (mean 55 years) and sex of the patient (according to various sources from 85 [3] to 94% of patients are women) [4]. In most cases, the disease is caused by the bacterium E. coli, which is isolated in 44 [5] – 57% of cases [1].…”

Section: Discussionmentioning

confidence: 99%

“…Changes, such as the characteristic presence of gas in EPN, observed in the tomographic images show no specificity in histopathology [9]. During the last few years, EPN–associated mortality has decreased to less than 25% [4]. It depends, among others, upon the strategy of treatment, ranging from 50% for patients treated only conservatively, 25% among patients in whom nephrectomy was performed and reaching 13.5% in those treated with antibiotic therapy in association with the assumption of percutaneous drainage [10].…”

Section: Discussionmentioning

confidence: 99%

Emphysematous pyelonephritis in a diabetic patient with obstructed kidney

Kutwin¹,

Konecki²,

Jabłonowski³

2014

CEJU

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Emphysematous pyelonephritis (EPN) is an acute, rare, inflammatory disease, which typically occurs in patients who suffer from diabetes mellitus. We report the case of a patient who was admitted to the Department of Urology with septic signs, in whom, after performing computed tomography, the diagnosis of EPN was established. The patient underwent organ–preserving treatment, which consisted of pyelolithotomy with nephrostomy, and the insertion of a double J catheter into the left ureter. The importance of the classification of EPN is also discussed. The need for individualized procedures is highlighted.

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Factores pronósticos en pielonefritis enfisematosa

Cited by 15 publications

References 15 publications

Emphysematous pyelonephritis: Time for a management plan with an evidence-based approach

Emphysematous pyelonephritis: Time for a management plan with an evidence-based approach

Utilidad de la procalcitonina y proteína C reactiva para predecir bacteriemia en las infecciones del tracto urinario en el servicio de urgencias

Emphysematous pyelonephritis in a diabetic patient with obstructed kidney

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