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Comparative study of emphysematous pyelonephritis and pyelonephritis in type 2 diabetes: a single-centre experience

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Abstract

Purpose

Emphysematous pyelonephritis (EPN) patients with type 2 diabetes (T2D) have severe complications and high morbidity with poor prognosis as compared to Pyelonephritis. The aim was to study clinical features, microbiological profile, complications of EPN and pyelonephritis in T2D patients.

Methods

This was a hospital-based prospective study done on 200 T2D patients with upper UTI. Various clinical, biochemical parameters and urine examination and culture were monitored. Patients were followed up for 6 months with respect to number of UTIs, glycemic control and renal parameters.

Results

Pyelonephritis was present in 180(90%) and EPN in 20(10%) of upper UTI patients. Longer duration of diabetes, presence of nephropathy, chronic kidney disease (CKD), hypertension (HTN), history of symptomatic UTI in a prior year, renal calculi and obstruction increase the risk of EPN. Patients with EPN commonly present with vomiting, flank pain altered sensorium and renal tenderness. Complications like diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), multiorgan dysfunction syndrome (MODS), acute kidney injury (AKI) and hypotension occur frequently in EPN as compared to pyelonephritis in T2D patients. Patients with EPN had poor glycemia and lower estimated glomerular filtration rate (eGFR) as compared to pyelonephritis. Bacteriuria was present in 90% and 66.7% of EPN and pyelonephritis patients respectively. E. coli was the most common isolate in both UTI groups. A significant number of EPN patients develop recurrent UTI. Patients with EPN have an improvement in glycemia on follow up, but renal parameters do not improve on follow up, while as pyelonephritis patients have an improvement in glycemia and renal parameters with intensive treatment. Recurrent UTI in upper UTI patients leads to worsening of glycemia and renal parameters.

Conclusion

Complications frequently occur in EPN patients as compared to pyelonephritis.

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References

  1. Joshi N, Caputo GM, Weitekamp MR, Karchmer A. Infections in patients with diabetes mellitus. N Engl J Med. 1999;341(25):1906–12.

    CAS  PubMed  Google Scholar 

  2. Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care. 2003;26(2):510–3.

    PubMed  Google Scholar 

  3. Bagdade JD. Infection in diabetes predisposing factors. Postgrad Med. 1976;59(1):160–4.

    CAS  PubMed  Google Scholar 

  4. McDonald HI, Nitsch D, Millett ER, Sinclair A, Thomas SL. New estimates of the burden of acute community-acquired infections among older people with diabetes mellitus: a retrospective cohort study using linked electronic health records. Diabet Med. 2014;31(5):606–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Chung VY, Tai CK, Fan CW, Tang CN. Severe acute pyelonephritis: a review of clinical outcome and risk factors for mortality. Hong Kong Med J. 2014;20(4):285–9.

    PubMed  Google Scholar 

  6. Kofteridis DP, Papadimitraki E, Mantadakis E, Maraki S, Papadakis JA, Tzifa G, Samonis G. Effect of diabetes mellitus on the clinical and microbiological features of hospitalized elderly patients with acute pyelonephritis. J Am Geriatr Soc. 2009;57(11):2125–8.

    PubMed  Google Scholar 

  7. Mnif MF, Kamoun M, Kacem FH, Bouaziz Z, Charfi N, Mnif F, et al. Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management. Indian J Endocrinol Metab. 2013;17(3):442–5.

    PubMed  PubMed Central  Google Scholar 

  8. Yu S, Fu AZ, Qiu Y, Engel SS, Shankar R, Brodovicz KG, Rajpathak S, Radican L. Disease burden of urinary tract infections among type 2 diabetes mellitus patients in the US. J Diabetes Complicat. 2014;28(5):621–6.

    Google Scholar 

  9. Nicolle L, Friesen D, Harding G, Roos L. Hospitalization for acute pyelonephritis in Manitoba, Canada, during the period from 1989 to 1992: impact of diabetes, pregnancy, and aboriginal origin. Clin Infect Dis. 1996;22(6):1051–6.

    CAS  PubMed  Google Scholar 

  10. Michaeli J, Mogle P, Perlberg S, Hemiman S, Caine M. Emphysematous pyelonephritis. J Urol. 1984;131(2):203–8.

    CAS  PubMed  Google Scholar 

  11. Gold RP, McClennan BL. Acute infection of the renal parenchyma. In: Pollack HM, editor. Clinical urography. 2nd ed. Philadelphia: Saunders; 1990. p. 799–821.

    Google Scholar 

  12. Schaeffer AJ. Infections of the urinary tract. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, Campbell M, editors. Campbell’s urology. 8th ed. Philadelphia: Saunders; 2002. p. 556–8.

    Google Scholar 

  13. Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk factors for mortality in patients with emphysematous pyelonephritis: a meta analysis. J Urol. 2007;178(3):880–5.

    PubMed  Google Scholar 

  14. Geerlings SE, Meiland R, Van Lith EC, Brouwer EC, Gaastra W, Hoepelman AI. Adherence of type 1-fimbriated Escherichia coli to uroepithelial cells. Diabetes Care. 2002;25(8):1405–9.

    PubMed  Google Scholar 

  15. Carton J, Maradona J, Nuno F, Fernandez-Alvarez R, Perez-Gonzalez F, Asensi V. Diabetes mellitus and bacteraemia: a comparative study between diabetic and non-diabetic patients. Eur J Med. 1992;1(5):281–7.

    CAS  PubMed  Google Scholar 

  16. Chiu PF, Huang CH, Liou HH, Wu CL, Wang SC, Chang CC. Long-term renal outcomes of episodic urinary tract infection in diabetic patients. J Diabetes Complicat. 2013;27(1):41–3.

    Google Scholar 

  17. Fünfstück R, Nicolle LE, Hanefeld M, Naber KG. Urinary tract infection in patients with diabetes mellitus. Clin Nephrol. 2012;77(1):40–8.

    PubMed  Google Scholar 

  18. Wang M-C, Tseng C-C, Wu A-B, Lin W-H, Teng C-H, Yan J-J, Wu JJ. Bacterial characteristics and glycemic control in diabetic patients with Escherichia coli urinary tract infection. J Microbiol Immunol Infect. 2013;46(1):24–9.

    PubMed  Google Scholar 

  19. Valerius N, Eff C, Hansen N, Karle H, Nerup J, Søeberg B, Sørensen SF. Neutrophil and lymphocyte function in patients with diabetes mellitus. Acta Med Scand. 1982;211(6):463–7.

    CAS  PubMed  Google Scholar 

  20. Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med. 1997;14(1):29–34.

    CAS  PubMed  Google Scholar 

  21. Hakeem L, Bhattacharyya D, Lafong C, Janjua K, Serhan J, Campbell I. Diversity and complexity of urinary tract infection in diabetes mellitus. Br J Diabetes Vasc Dis. 2009;9(3):119–25.

    Google Scholar 

  22. Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU Int. 2011;107(9):1474–8.

    PubMed  Google Scholar 

  23. Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N’Dow J, ABACUS Research Group. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008;179(5):1844–9.

    PubMed  Google Scholar 

  24. Bucchanan R, Gibbons M. Bergey’s manual of determinative bacteriology. 8th ed. Williams and Wilkins Baltimaore: Baltimore; 1974.

    Google Scholar 

  25. Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing: Twenty-fifth Information Supplement M100-S25 CLSI, Wayne, PA USA 2015.

  26. Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes. 2015;8:129–36.

    PubMed  PubMed Central  Google Scholar 

  27. Boyko EJ, Fihn SD, Scholes D, Abraham L, Monsey B. Risk of urinary tract infection and asymptomatic bacteriuria among diabetic and nondiabetic postmenopausal women. Am J Epidemiol. 2005;161(6):557–64.

    PubMed  Google Scholar 

  28. Geerlings SE, Stolk RP, Camps MJ, Netten PM, Hoekstra JB, Bouter KP, Bravenboer B, Collet JT, Jansz AR, Hoepelman AI. Asymptomatic bacteriuria may be considered a complication in women with diabetes. Diabetes mellitus women asymptomatic Bacteriuria Utrecht study group. Diabetes Care. 2000;23(6):744–9.

    CAS  PubMed  Google Scholar 

  29. Sewify M, Nair S, Warsame S, Murad M, Alhubail A, Behbehani K, et al. Prevalence of urinary tract infection and antimicrobial susceptibility among diabetic patients with controlled and uncontrolled glycemia in Kuwait. J Diabetes Res 2016;11(1):1–7.

  30. Kumar S, Ramachandran R, Mete U, Mittal T, Dutta P, Kumar V, Rathi M, Jha V, Gupta KL, Sakhuja V, Kohli HS. Acute pyelonephritis in diabetes mellitus: single center experience. Indian J Nephrol. 2014;24(6):367–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Chiţă T, Timar B, Muntean D, Bădiţoiu L, Horhat F, Hogea E, et al. Urinary tract infections in Romanian patients with diabetes: prevalence, etiology, and risk factors. Ther Clin Risk Manag. 2017;13(1):1–7.

    PubMed  Google Scholar 

  32. Janifer J, Geethalakshmi S, Satyavani K, Viswanathan V. Prevalence of lower urinary tract infection in south Indian type 2 diabetic subjects. Indian J Nephrol. 2009;19(3):107–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Robbins SL, Tucker AW Jr. The cause of death in diabetes: a report of 307 autopsied cases. N Engl J Med. 1944;231(26):865–8.

    Google Scholar 

  34. Huang JJ, Tseng CC. Emphysematous pyelonephritis clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000;160(6):797–805.

    CAS  PubMed  Google Scholar 

  35. Aswani SM, Chandrashekar U, Shivashankara K, Pruthvi B. Clinical profile of urinary tract infections in diabetics and non-diabetics. Australas Med J. 2014;7(1):29–34.

    PubMed  PubMed Central  Google Scholar 

  36. Garg V, Bose A, Jindal J, Goyal A. Comparison of clinical presentation and risk factors in diabetic and non-diabetic females with urinary tract infection assessed as per the European Association of Urology classification. J Clin Diagn Res. 2015;9(6):12–4.

    Google Scholar 

  37. Nkume FA, Chongsi ME, Mbuntum JF, Tanjeko AT, Kwenti TE. Glycemic control and urinary tract infection in diabetes mellitus: a cross sectional study. Res Rev: J Med Health Sci. 2014;3(1):83–8.

    Google Scholar 

  38. Balasoiu D, van Kessel KC, van Kats-Renaud HJ, Collet TJ, Hoepelman AI. Granulocyte function in women with diabetes and asymptomatic bacteriuria. Diabetes Care. 1997;20(3):392–5.

    CAS  PubMed  Google Scholar 

  39. Fatima R, Jha R, Muthukrishnan J, Gude D, Nath V, Shekhar S, Narayan G, Sinha S, Mandal SN, Rao BS, Ramsubbarayudu B. Emphysematous pyelonephritis: a single center study. Indian J Nephrol. 2013;23(2):119–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Sharma S, Govind B, Naidu SK, Kinjarapu S, Rasool M. Clinical and laboratory profile of urinary tract infections in type 2 diabetics aged over 60 years. J Clin Diagn Res. 2017;11(4):25–8.

    Google Scholar 

  41. Pérez-Luque EL, de la Luz VM, Malacara JM. Association of sexual activity and bacteriuria in women with non-insulin-dependent diabetes mellitus. J Diabetes Complicat. 1992;6(4):254–7.

    Google Scholar 

  42. Gorter KJ, Hak E, Zuithoff NP, Hoepelman AI, Rutten GE. Risk of recurrent acute lower urinary tract infections and prescription pattern of antibiotics in women with and without diabetes in primary care. Fam Pract. 2010;27(4):379–85.

    PubMed  Google Scholar 

  43. Ikähelmo R, Siitonen A, Heiskanen T, Kärkkäinen U, Kuosmanen P, Lipponen P, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis. 1996;22(1):91–9.

    Google Scholar 

  44. Foxman B, Gillespie B, Koopman J, Zhang L, Palin K, Tallman P, Marsh JV, Spear S, Sobel JD, Marty MJ, Marrs CF. Risk factors for second urinary tract infection among college women. Am J Epidemiol. 2000;151(12):1194–205.

    CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to express their greatest gratitude to all participating patients, health professionals and community support group members, who provided assistance for this study. I am thankful to Dr. Feroz Ahmad for helping me in the statistical analysis of the data. I also thank the technical department of microbiology.

Funding

Funding for the project was received from institutional grant commission.

Author information

Authors and Affiliations

  1. Department of Endocrinology, MMIMSR, Ambala, Haryana, India

    Tauseef Nabi

  2. Department of Physiology, Govt. Medical College, Baramulla, J&K, India

    Nadeema Rafiq

  3. Department of Community Medicine, MMIMSR, Ambala, Haryana, India

    Mohammad Hifz Ur Rahman

  4. Department of Urology, Govt. Medical College, Srinagar, J&K, India

    Shahnawaz Rasool

  5. Department of Microbiology, Govt. Medical College, Srinagar, J&K, India

    Nayeem U Din Wani

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  1. Tauseef Nabi
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Correspondence to Tauseef Nabi.

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Nabi, T., Rafiq, N., Rahman, M.H.U. et al. Comparative study of emphysematous pyelonephritis and pyelonephritis in type 2 diabetes: a single-centre experience. J Diabetes Metab Disord 19, 1273–1282 (2020). https://doi.org/10.1007/s40200-020-00640-y

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  • DOI: https://doi.org/10.1007/s40200-020-00640-y

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