Open AccessEmphysematous Pyelonephritis: Experience at a Tertiary Care Hospital in Bangladesh
Author(s) -
Muhammad Abdur Rahim,
Mehruba Alam Ananna,
Sarwar Iqbal,
Khwaja Nazim Uddin,
Zafar Ahmed Latif
Publication year - 2021
Publication title -
journal of the royal college of physicians of edinburgh/the journal of the royal college of physicians of edinburgh
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.275
H-Index - 26
eISSN - 2042-8189
pISSN - 1478-2715
DOI - 10.4997/jrcpe.2021.106
Subject(s) - medicine , dysuria , vomiting , acute kidney injury , nephrectomy , diabetes mellitus , surgery , retrospective cohort study , urinary system , adipose capsule of kidney , kidney , endocrinology
Background Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN. Methods This retrospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between 2014 and 2020. Results We followed 20 patients (mean age 49.4 years; females 70%). Risk factors for EPN were diabetes mellitus (in 100%) and renal stones (in 10%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury (AKI, 70%; mostly stage 1, 78.6%), hyponatraemia (55%) and bacteraemia (15%). Escherichia coli was the most common (60%) urinary isolate. Most patients (80%) had class 2 EPN, with 15% class 3B and 5% class 3A. Besides medical management, four (20%) required surgery (nephrectomy in 3). Nephrectomised patients had a higher radiological class (p = 0.032) and incidence of AKI (p = 0.034). No deaths occurred. Conclusion EPN occurred predominantly in female diabetic patients, who presented with fever, loin pain, vomiting and dysuria. Two-thirds of patients had AKI and one-fifth required surgery, and there were no deaths.