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Deriving a management algorithm for emphysematous pyelonephritis: Can we rely on minimally invasive strategies or should we be opting for earlier nephrectomy?

  • Urology - Original Paper
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Abstract

Purpose

To analyse the incidence and management of emphysematous pyelonephritis (EPN) in North West London and examine factors that influence immediate and 6-month outcomes with the aim of guiding future management.

Methods

This work analyses EPN cases from the London North West Healthcare NHS Trust from October 2006 to July 2015 (population ≈ 850,000). Diagnosis and stage were confirmed by computed tomography (CT). Demographic, clinical, biochemical and microbiological characteristics were assessed. Treatment modalities were medical management, minimally invasive management (MIM) and surgical. Immediate and 6-month outcomes were analysed.

Results

Thirteen cases were identified (f = 8, m = 5) from 5525 CT scans. EPN occurred in patients with diabetes mellitus (n = 11, 84.6%), hypertension (n = 10, 76.9%) or urinary tract calculi (n = 7, 53.85%). Unilateral EPN occurred predominantly (n = 11, 84.6%); 46.1% (n = 6) were class 1 or 2 and 53.8% (n = 7) class 3 or 4. Escherichia coli was most commonly cultured (n = 5, 38.46%). All patients received antibiotics, and ten cases required MIM. Two patients had a delayed nephrectomy, both survived. Mortality was 15.4% (n = 2, grade 1 and 3a), both died acutely post-MIM, neither underwent emergency nephrectomy. At 6 months, eight patients had ongoing renal impairment. No specific poor prognostic factors were identifiable.

Conclusions

Patients with low-grade EPN may also have a high mortality rate. In the two cases who died, earlier consideration for nephrectomy may have been prudent. It may be beneficial to have a low threshold for prompt emergency nephrectomy in severe cases and where MIM treatment has failed. We suggest a management algorithm to guide clinicians and minimise mortality.

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Acknowledgements

We would like to thank Dipesh Hirani and Neil Barron for data searches in the radiology reporting system (Spectra PACS).

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Authors and Affiliations

  1. Department of Urology, London North West Healthcare NHS Trust, Harrow, London, UK

    Eve Boakes & Deepak Batura

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  1. Eve Boakes
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  2. Deepak Batura
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Correspondence to Eve Boakes.

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Neither author has any conflicts of interest to declare.

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This article does not contain any studies with animals performed by any of the authors. This study was carried out in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments.

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This was a retrospective study with anonymised data, not requiring informed consent.

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Boakes, E., Batura, D. Deriving a management algorithm for emphysematous pyelonephritis: Can we rely on minimally invasive strategies or should we be opting for earlier nephrectomy?. Int Urol Nephrol 49, 2127–2136 (2017). https://doi.org/10.1007/s11255-017-1706-8

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  • DOI: https://doi.org/10.1007/s11255-017-1706-8

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