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Is conservative management Is conservative management effective in Emphysematous effective in Emphysematous
Acute necrotizing parenchymal and Acute necrotizing parenchymal and perirenal infection caused by gas perirenal infection caused by gas forming organisms.forming organisms.
High morbidity & poor prognosis.High morbidity & poor prognosis. Rate of Nephrectomy: 21-29% Rate of Nephrectomy: 21-29% Mortality rate: 60-75%Mortality rate: 60-75%
AIMAIM
To analyze the efficacy of To analyze the efficacy of conservative management in EPN.conservative management in EPN.
Methods Methods Retrospective studyRetrospective study
Inclusion criteria: All patients of EPN managed in Inclusion criteria: All patients of EPN managed in our centre in the last three years.our centre in the last three years.
Diagnosis of EPN: Based on clinical and Diagnosis of EPN: Based on clinical and radiological findingsradiological findings
The risk factors and classification done based on The risk factors and classification done based on study by Wan et al study by Wan et al **
Correlation between imaging finding & clinical outcome ; Liang Wan, Tze u lee ; Correlation between imaging finding & clinical outcome ; Liang Wan, Tze u lee ; Radiology 1996; 198: 433-438Radiology 1996; 198: 433-438
Classification according to Classification according to extent of involvementextent of involvement
Class I : Renal pelvisClass I : Renal pelvis Class II : Renal parenchymaClass II : Renal parenchyma Class III Class III
A : Perinephric tissueA : Perinephric tissueB : Beyond Gerota’s fascia. B : Beyond Gerota’s fascia.
Class IV : Bilateral involvement Class IV : Bilateral involvement EPN in solitary kidney EPN in solitary kidney
Type IType I – Parenchymal destruction, absence of – Parenchymal destruction, absence of fluid collections and presence of mottled gas fluid collections and presence of mottled gas (Dry type) – Mortality : 69%(Dry type) – Mortality : 69%
Type IIType II – Renal or perirenal collections with – Renal or perirenal collections with bubbly or loculated gas or gas in collecting bubbly or loculated gas or gas in collecting system. (Wet type) Mortality : 18%system. (Wet type) Mortality : 18%
Wan et al 1996, Best et al 1999Wan et al 1996, Best et al 1999
Risk factorsRisk factors
ThrombocytopeniaThrombocytopenia Acute renal insufficiencyAcute renal insufficiency Low S. AlbuminLow S. Albumin Altered mental statusAltered mental status Shock on presentationShock on presentation
AUA, 2005AUA, 2005
More than 2 risk factors – Poorer prognosisMore than 2 risk factors – Poorer prognosis
Conservative Management in EPNConservative Management in EPN
Conservative management is a safe, Conservative management is a safe, effective and feasible treatment effective and feasible treatment option in patients with option in patients with Emphysematous pyelonephritis.Emphysematous pyelonephritis.