Emphysematous pyelonephritis: The role of renal conservation

Gokul, A V (2007) Emphysematous pyelonephritis: The role of renal conservation. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Emphysematous pyelonephritis was first reported by Kelly and MacCallum in 1898 and was considered to be rare. The term EPN was first used by Schultz and Klorfein and is applied when gas is formed only in or around the kidney. The lack of a strict definition of EPN has resulted in the use of multiplicity of terms, such as renal emphysema, pneumonephritis, pyelonephritis emphysematosa and pneumonephrogram. As suggested by Schultz and Klorfein, emphysematous pyelonephritis is the preferred designation. Gas-forming bacteria using glucose as a substrate cause necrotizing lesions in infected tissue, especially in diabetic patients or those with an obstructive urinary tract infection. EPN can be complicated by acute sepsis, resulting in a poor prognosis. Thus the disease presents a urologic emergency. It deserves special attention because of its life-threatening potential. Mortality rates associated with Emphysematous pyelonephritis vary from 7 to 75%. It has generally been regarded as a rare infection in the earlier reports. However, with the more extensive use of ultrasonography and computed tomography in the evaluation of patients with features of sepsis or complicated urinary tract infection (UTI), more cases of Emphysematous pyelonephritis (EPN) are being recognized. Huang et al believe that EPN is not rare and should be considered an important clinical entity. AIMS AND OBJECTIVES: 1) To study the feasibility of renal conservation in emphysematous pyelonephritis. 2) To analyse the various prognostic factors that favour renal conservation in emphysematous pyelonephritis. MATERIALS AND METHODS: This was a prospective study conducted in Kilpauk Medical College in its constituent hospitals Kilpauk Medical College Hospital and Government Royapettah Hospital from September 2004 to April 2007. Inclusion criteria: 1) Patients with features of acute pyelonephritis with gas in the renal parenchyma and beyond it, The symptoms were Fever, chills, loin pain, vomiting. 2) Patients admitted in the emergency, but subsequently evaluated and found to have gas in the renal parenchyma and beyond it with features of acute pyelonephritis. Exclusion criteria: 1) Patients with features of acute pyelonephritis without gas in the renal parenchyma, 2) History of recent endoscopic or open interventions in the urinary Tract, 3) History of recent catheterization. RESULTS: The descriptive statistics of the study population and their derived variables including the mean, standard deviation and maximum and minimum values. Sample size: Total number of patients included in this study was 25. Age: The mean age was 55.12 yrs with a standard deviation of 9.71.The youngest patient was 38 yrs and the oldest was 82 yrs old. Age was not significantly related to the outcomes in our study (p=0.094). Sex: 62% of the total cases were males and 32% were females. There was no significant relationship between sex and outcomes (p=0.0607). CONCLUSION: 1) There is a definite role for renal conservation in properly selected patients of emphysematous pyelonephritis. 2) The following factors at presentation could tilt the balance towards nephrectomy in conservatively managed cases of emphysematous pyelonephritis • Shock, • Altered mental status, • Raised serum creatinine, • Total count >10000/cmm, • Platelet count < 120000/cmm, • Positive blood cultures, • Absence of urinary tract obstruction.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Emphysematous ; pyelonephritis ; renal conservation.
Subjects: MEDICAL > Urology
Depositing User: Kambaraman B
Date Deposited: 12 Oct 2017 01:07
Last Modified: 12 Oct 2017 01:07
URI: http://repository-tnmgrmu.ac.in/id/eprint/3433

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