TY - JOUR
T1 - Renal salvage, an achievable goal in patients with emphysematous pyelonephritis
T2 - Outcomes of an algorithmic renal preserving strategy
AU - Adapala, Rajeshkumar Reddy
AU - Shetty, Ranjit
AU - Venugopal, P.
AU - Prabhu, G. G.L.
AU - Yalla, Durgarao
AU - Unnikrishnan, B.
N1 - Publisher Copyright:
© 2020 Urology Annals | Published by Wolters Kluwer - Medknow.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Introduction: Emergency nephrectomy has been the time-honored treatment of choice for emphysematous pyelonephritis (EPN), a fatal gas-forming necrotizing infection. Recent years have seen a shift toward nonextirpative approach aimed to achieve higher rates of renal salvage, limiting the indications for nephrectomy to severe grades of the disease. This study aimed at analyzing the role of initial renal preserving measures algorithmically applied across grades of EPN. Materials and Methods: We prospectively analyzed the clinical data and outcome of 36 consecutive patients of EPN in 5 years' study period, treated by renal preserving measures, which include aggressive resuscitation, parenteral antibiotics, effective drainage of infected fluid/gas, and relieving the urinary tract obstruction. Huang-Tseng computed tomography-based classification system was used to categorize the patients as well as to employ suitable treatment modality. Results: The mean age of the patients was 57.5 ± 12 years with female preponderance (2:1). Diabetes mellitus (97%) was the most common associated factor. Escherichia coli was (72%) the most frequent causative organism found. Urinary tract obstruction was seen in 27 patients (75%) attributable to ureteric calculi, renal papillary necrosis, ureteric stricture, and fungal bezoar in the descending order of frequency. Only 2 (6%) out of 36 patients managed according to our hospital renal salvage protocol required salvage nephrectomy. The overall survival rate was 94%. Conclusion: Our hospital-based algorithmic renal preserving strategy not only improved the survival but also decreased the need for nephrectomy.
AB - Introduction: Emergency nephrectomy has been the time-honored treatment of choice for emphysematous pyelonephritis (EPN), a fatal gas-forming necrotizing infection. Recent years have seen a shift toward nonextirpative approach aimed to achieve higher rates of renal salvage, limiting the indications for nephrectomy to severe grades of the disease. This study aimed at analyzing the role of initial renal preserving measures algorithmically applied across grades of EPN. Materials and Methods: We prospectively analyzed the clinical data and outcome of 36 consecutive patients of EPN in 5 years' study period, treated by renal preserving measures, which include aggressive resuscitation, parenteral antibiotics, effective drainage of infected fluid/gas, and relieving the urinary tract obstruction. Huang-Tseng computed tomography-based classification system was used to categorize the patients as well as to employ suitable treatment modality. Results: The mean age of the patients was 57.5 ± 12 years with female preponderance (2:1). Diabetes mellitus (97%) was the most common associated factor. Escherichia coli was (72%) the most frequent causative organism found. Urinary tract obstruction was seen in 27 patients (75%) attributable to ureteric calculi, renal papillary necrosis, ureteric stricture, and fungal bezoar in the descending order of frequency. Only 2 (6%) out of 36 patients managed according to our hospital renal salvage protocol required salvage nephrectomy. The overall survival rate was 94%. Conclusion: Our hospital-based algorithmic renal preserving strategy not only improved the survival but also decreased the need for nephrectomy.
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U2 - 10.4103/UA.UA_67_19
DO - 10.4103/UA.UA_67_19
M3 - Article
AN - SCOPUS:85084231896
SN - 0974-7796
VL - 12
SP - 156
EP - 162
JO - Urology Annals
JF - Urology Annals
IS - 2
ER -