Emphysematous Pyelonephritis: A single center review

Background and Objective: Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing renal parenchymal infection. Traditional management of EPN with nephrectomy had a mortality of 40-50%. The purpose of this case series was to assess the management, biochemical factors, and outcome of EPN patients. Methods: In this retrospective study, patients admitted to The Indus Hospital, Karachi with a diagnosis of EPN from January 2010 to February 2019, were grouped according to the Huang Tseng Classification (HTC). Their biochemical parameters, sensorium states and outcomes were recorded and analysed. Results: Twenty patients were reviewed (9 males). No mortality was recorded. 11 patients (55%) were treated conservatively with only intravenous antibiotics and eight patients underwent an intervention: minimally invasive with drain placement in six patients, and invasive in four patients (two underwent subsequent nephrectomy, and two patients had nephrectomy only). One patient left against medical advice. All patients had decreased serum creatinine levels and total leucocyte counts on discharge. Conclusion: EPN can be successfully managed conservatively for HTC Grade-1 and 2. Conservative treatment may be tried in higher grades, but poor response should lead to prompt escalation of treatment.