CONSERVATIVE MANAGEMENT OF EMPHYSEMATOUS PYELONEPHRITIS: THE SHIFTING TREND

Abstract

Emphysematous pyelonephritis (EPN) is a potentially life threatening necrotizing pyelonephritis due to gas producing organisms. The objective of this study was to see the prognosis of patients of emphysematous pyelonephritis on conservative management. Methods: A Prospective Case series study was conducted at tertiary care hospitals of Army, Rawalpindi from Jan 2011 to Nov 2015. A total of 12 patients were evaluated in the study. All patients were managed conservatively and had hospital stay of maximum 3 weeks. Results: Of the 12 diagnosed diabetic patients (8 females and 4 males) 1 was class I emphysematous pyelonephritis, 4 were class II, 5 of class III a, 1 class III b and 1 case was of class IV. Fever and flank tenderness were the commonest presenting symptoms. All had positive renal punch and impaired renal functions. Four patients had thrombocytopenia and one patient presenting in shock died within 48 hours. All patients were initially managed with a protocol of aggressive fluid resuscitation, strict blood sugar control and broad spectrum antibiotics. Ultrasound guided percutaneous nephrostomy was done in seven patients for drainage. All patients responded well to conservative management except one needing nephrectomy. Conclusion: