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Inicio Actas Urológicas Españolas (English Edition) Prognostic factors in emphysematous pyelonephritis
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Vol. 37. Issue 4.
Pages 228-232 (April 2013)
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Vol. 37. Issue 4.
Pages 228-232 (April 2013)
Original article
Prognostic factors in emphysematous pyelonephritis
Factores pronósticos en pielonefritis enfisematosa
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D. Olvera-Posada??
Corresponding author
danielolveraposada@gmail.com

Corresponding author.
, A. García-Mora, C. Culebro-García, R. Castillejos-Molina, M. Sotomayor, G. Feria-Bernal, F. Rodríguez-Covarrubias
Departamento de Urología e Imagenología (CCG), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
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Tables (4)
Table 1. Clinical features at initial workup and associated diseases.
Table 2. Classification according to initial presentation.
Table 3. Radiological classifications and associated findings.
Table 4. Univariate analysis of factors associated with mortality.
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Abstract
Objectives

The purpose of this study is to analyze our experience with 18 cases of Emphysematous pyelonephritis (EPN) in a tertiary care center and describe our treatment strategy.

Material and methods

Of 262 patients admitted with acute pyelonephritis, 18 had CT findings of EPN. The Wan and Huang classifications were used. We assessed the clinical, radiological, and therapeutic characteristics of these patients and investigated potential prognostic factors of mortality.

Results

Between 2005 and 2010, 17 women and 1 man with EPN were treated. Mean age was 52.4 years. Diabetes was found in 66% and hypertension in 72%. The most common clinical findings were tachycardia (11), fever (11) and flank pain (9); 66% (12) presented with severe sepsis and 2 had septic shock. Acute renal injury developed in 61%. Nine patients were treated exclusively with conservative management; 5 had double J stenting, 3 had CT-guided PCD and 1 required nephrectomy after unsuccessful medical management. Mortality was 11%. Altered consciousness (P=.0001), multiple organ failure (P=.0004), hyperglycemia (P=.003) and elevated leukocyte count (>20000K) (P=.01) were more frequent among patients dying from EPN. No difference in mortality was found between patients managed conservatively and those undergoing invasive therapy.

Conclusions

Although rare, EPN should be suspected in patients with multiple comorbidities presenting with severe sepsis. Altered consciousness, multiple organ failure, hyperglycemia and elevated leukocyte count are poor prognosis indicators. Invasive management should be used judiciously and medical treatment can be a safe strategy in selected cases.

Keywords:
Emphysematous pyelonephritis
Prognosis
Sepsis
Urinary tract infection
Resumen
Objetivos

Analizar nuestra experiencia con 18 casos de pielonefritis enfisematosa (PE) en un centro de tercer nivel.

Material y métodos

De 262 pacientes hospitalizados por pielonefritis aguda, 18 mostraron hallazgos radiológicos de PE. Utilizamos la clasificación de Wan y Huang. Analizamos las características clínicas, radiológicas y terapéuticas de los pacientes. Buscamos factores pronósticos de mortalidad.

Resultados

De 2005 a 2010 17 mujeres y un hombre recibieron tratamiento por PE. La media de edad fue de 52,4 años. El 72% de los pacientes padecían hipertensión y el 66% diabetes tipo 2. Los hallazgos clínicos más comunes fueron: taquicardia (11), fiebre (11) y dolor en flanco (9). Doce pacientes presentaron sepsis grave y 2 choque séptico. El 61% de los pacientes tuvo insuficiencia renal aguda a su ingreso. Nueve sujetos recibieron manejo conservador; se colocó catéter doble J a 5 pacientes y drenaje percutáneo a 3. Solo realizamos una nefrectomía después de un manejo conservador no exitoso. La mortalidad fue del 11%. Las alteraciones en el estado de conciencia (p=0,0001), disfunción orgánica múltiple (p=0.0004), hiperglucemia (p=0,003) y leucocitosis (>20.000 K) (p=0,01) fueron más comunes en aquellos pacientes que no sobrevivieron. No hubo diferencias en mortalidad entre los pacientes tratados de forma conservadora (solo manejo médico) y aquellos que recibieron tratamiento invasivo.

Conclusiones

La PE debe sospecharse en pacientes con múltiples comorbilidades que se presentan con sepsis grave. La alteración en el estado de alerta, la disfunción orgánica múltiple, la hiperglucemia y la leucocitosis son factores de mal pronóstico. El tratamiento invasivo debe utilizarse de forma juiciosa, y el tratamiento conservador puede ser una estrategia segura en casos seleccionados.

Palabras clave:
Pielonefritis enfisematosa
Pronóstico
Sepsis
Infección de vías urinarias

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