Risk Factors For Mortality In Patients With Emphysematous Pyelonephritis: A Meta Analysis

Main Category: Urology / Nephrology
Also Included In: Clinical Trials / Drug Trials
Article Date: 21 Nov 2007 - 0:00 PDT

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UroToday.com- Emphysematous pyelonephritis on radiographic imaging is well known as an ominous diagnosis. There have been several sporadic reports over the years with regards to this entity and this meta-analysis report nicely summarizes seven of these representing 175 patients with emphysematous pyelonephritis. The main factors associated with increased mortality include conservative treatment alone, bilateral emphysematous pyelonephritis, type 1 emphysematous pyelonephritis (characterized by renal parenchymal necrosis with absence of fluid content or presence of a streaky/mottled gas pattern), and thrombocytopenia.

Type 2 emphysematous pyelonephritis is characterized by presence of renal or perirenal fluid accompanied by a bubbly gas pattern or presence of gas in the collecting system. Therefore, immediate operative intervention is indicated for patients with type 1 emphysematous pyelonephritis. However, even despite this aggressive treatment these patients are at high risk of mortality; overall 25% mortality rate. Although it is more commonly seen in patients with diabetes this meta-analysis found no association between diabetes and mortality in patients with emphysematous pyelonephritis.

This was also the case with nephrolithiasis and infection due to E. coli or Klebsiella. Increased serum creatinine level, disturbance of consciousness, and hypotension (systolic blood pressure less than 90 mmHg) may also impact the mortality rate of these patients but there is limited data on these factors. It can often be difficult to distinguish type 1 emphysematous pyelonephritis from type 2 based on radiographic imaging alone.

Therefore, nephrectomy should be performed as soon as possible after vigorous resuscitation, administration of antimicrobial agents, and control of blood glucose and electrolytes. Bilateral emphysematous pyelonephritis may be reasonably considered as a more severe infection, thereby increasing its mortality rate. These patients are often too sick to undergo general anesthesia. A high level of suspicion for this diagnosis, aggressive surgical management and resuscitative measures will have the best chance of saving these patients.

Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II
J Urol.178 (3):880-885, September 2007
doi:10.1016/j.juro.2007.05.017

Reported by UroToday.com Contributing Editor Elspeth M. McDougall, M.D

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