Publication:

Case series to study the clinical features, risk factors, prognostic factors, and to assess the different management modalities of EPN and its outcomes

Background Emphysematous pyelonephritis is an acute necrotising infection of the kidney, often associated with high rate of renal loss and mortality. EPN mostly present with triad of fever, flank pain and nausea. The diagnostic tool of choice is CT KUB. E. coli is the most common pathogen.

Methods It was prospective study done on 52 patients who were diagnosed to have EPN from department of nephrology and urology in Narayana Medical College, Nellore from March 2022 to January 2024. The diagnosis of EPN was confirmed by plain CT KUB scan.

Results Among 52 patients 48 patients had diabetes mellitus (DM). left kidney involved in 28 patients and right kidney involved in 16 patients and bilateral kidney involvement in 8. Fever (92%), flank pain (88%) are the most common presentation in patients. Shock during initial presentation was seen in 19.5% of patients. E. coli growth was seen in 26.9% cases. 8 patients were treated conservatively with antibiotics according to culture and sensitivity. 32 patients required double J stenting, 7 patients required percutaneous nephrostomy. Nephrectomy was done in 5 patients. Mortality rate in our study was zero.

Conclusions Nephrectomy should be promptly attempted for patients not responding to conservative methods. Pre-existing CKD status, shock at presentation and altered sensorium are the factors determining the prognosis and management.