Kaohsiung Journal of Medical Sciences
Volume 25, Issue 1 , Pages 16-24, January 2009

Reappraisal of the Management and Outcome of Emphysematous Pyelonephritis

  • Wei-Ching Lin

      Affiliations

    • Institute of Clinical Medical Science, Nantou, Taiwan
    • Department of Biomedical Imaging and Radiological Science, China Medical University, Nantou, Taiwan
    • ,
  • Yung-Fang Chen

      Affiliations

    • Department of Radiology, China Medical University Hospital, Nantou, Taiwan
    • ,
  • Chien-Heng Lin

      Affiliations

    • Institute of Clinical Medical Science, Nantou, Taiwan
    • Department of Pediatrics, Jen-Ai Hospital, Nantou, Taiwan
    • ,
  • Yung-Jen Ho

      Affiliations

    • Department of Radiology, China Medical University Hospital, Nantou, Taiwan
    • ,
  • Yuan-Hong Tzeng

      Affiliations

    • Department of Radiology, Lin-Shin Hospital, Taichung, Nantou, Taiwan
    • ,
  • Hsein-Jar Chiang

      Affiliations

    • Department of Radiology, Nantou Christian Hospital, Nantou, Taiwan
    • ,
  • Chao-Hsiang Chang

      Affiliations

    • Department of Urology, China Medical University Hospital, Nantou, Taiwan
    • ,
  • Yi-Chang Cheng

      Affiliations

    • Department of Emergency Medicine, China Medical University Hospital, Nantou, Taiwan
    • ,
  • Wu-Chung Shen

      Affiliations

    • Department of Radiology, China Medical University Hospital, Nantou, Taiwan
    • ,
  • Jeon-Hor Chen

      Affiliations

    • Department of Radiology, China Medical University Hospital, Nantou, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Jeon-Hor Chen, Department of Radiology, China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taiwan

Received 16 January 2008; accepted 23 September 2008.

Article Outline

This study compared the management, prognostic factors and outcomes of patients with emphysematous pyelonephritis (EPN). Twenty-one patients with EPN were studied between September 1996 and August 2005, and were assigned to two groups. Patients in Group 1 received conservative treatment with/without percutaneous catheter drainage (PCD) while patients in Group 2 underwent nephrectomy following medical treatment and PCD. A post hoc analysis of the prognostic factors was performed between survivors and nonsurvivors, and between the survivors in Group 1 and Group 2. There were 14 patients in Group 1, and seven in Group 2. The mortality in Group 1 was 35.7% (5/14) and in Group 2 was 0% (p = 0.12). There were no statistically significant differences in prognostic factors between the two groups, though patients in Group 1 had relatively lower platelet counts (p = 0.07) and Group 2 patients had a higher incidence of dialysis after nephrectomy (p = 0.03). Comparing the survivors and nonsurvivors, patients with comorbid congestive heart failure and patients initially presenting with consciousness disturbances had higher mortalities (p = 0.02 and p < 0.01, respectively). Nonsurvivors also had lower platelet counts (p = 0.06). In conclusion, medical treatment with/without PCD can be used to manage patients with EPN. More aggressive drainage is needed in patients with congestive heart failure who initially present with consciousness disturbances or thrombocytopenia.

Key Words:  emphysematous pyelonephritis , nephrectomy , percutaneous catheter drainage

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PII: S1607-551X(09)70035-X

doi:10.1016/S1607-551X(09)70035-X

Kaohsiung Journal of Medical Sciences
Volume 25, Issue 1 , Pages 16-24, January 2009

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