A Tyagi¹, K.Venkat Reddy² , K V Bhargava Reddy³, J Jayaraju⁴, Lokesh⁵

¹Professor and Head, ²,³,⁴,⁵Final year Resident,Department of Urology, Sri Venkateswara Institute of Medical Sciences,Tirupathi,Andhra Pradesh.India.

Address for correspondence: Dr. A.Tyagi,Professor and Head,Department of Urology,Sri Venkateswara Institute of Medical Sciences,Tirupathi,Andhra Pradesh.India.

Email: tyagi.swarna20@gmail.com

Objective: : Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma; it causes gas formation within the collecting system, renal parenchyma, and/or perirenal tissues . Gas in the renal pelvis alone, without parenchymal gas, is often referred to as emphysematous pyelitis. The main objective of this study is to elucidate the clinical features,radiological classification, prognostic factors of Emphysematous pyelonephritis , to compare the modalities of management and outcomes among various radiological classes of EPN.

Materials & Methods: The present study was conducted among the patients who were admitted between September 2013 to September 2015. 34 consecutive cases diagnosed as EPN were included in the study. The baseline characteristics , laboratory data, abdominal CT scan was taken. Based on CT scan staging , HDN/HDUN/collection was managed with PCN/DJ stenting/ PCD/nephrectomy and results noted.

Results: The mean age of our patients was 55 years , with a male to female ratio of 1.2:1. The most common predisposing factor was diabetes (28 cases-82%) followed by urolithiasis. Right side (50%) was more commonly affected than left (35.3%). Five patients (11.7%) had bilateral involvement and one had EPN of solitary kidney (2.9%). 2 patients (6%) received antibiotics alone , four (12%) had an early nephrectomy , 25 (73%) received PCD/PCN/DJ stenting alone and 3(9%) had delayed nephrectomy after initial PCD

Conclusion: Traditionally EPN is associated with high mortality, but presently the mortality rates seem to be reducing because of improved staging modalities and effective antibiotics /PCD/PCN/DJ stenting.Identification of prognostic factors may stratify patients for conservative or surgical management.In the era of effective antibiotics & interventional radiology the threshold for early nephrectomy should be high, which is associated with high mortality Keywords :: Emphysematous pyelonephritis, nephrectomy, necrotizing infection, renal parenchyma.