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Emphysematous pyelonephritis: time for a management plan with an evidence-based approach

Emphysematous pyelonephritis: time for a management plan with an evidence-based approach
Emphysematous pyelonephritis: time for a management plan with an evidence-based approach
Introduction: emphysematous pyelonephritis (EPN) is a life-threatening necrotising kidney infection, but there is no consensus on the best management.Methods: we systematically reviewed previous articles published from 1980 to 2013 that included studies reporting on EPN, and applying the Cochrane guidelines, we conducted a meta-analysis of the results.Results: in all, 32 studies were included, with results for 628 patients (mean age 56.6 years, range 33.8–79.9). There were 462 women, outnumbering men by 3:1. Diabetes was present in 85% of the cases. Fevers and rigor (74.7%), pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was associated with 54.4% of deaths while obstructive uropathy was associated with 15.1% of deaths. Computed tomography was diagnostic in all the cases. Percutaneous drainage (PCD) and medical management (MM) alone were associated with a significantly lower mortality rate than was emergency nephrectomy (EN), with an odds ratio (95% confidence interval) for PCD vs. EN of 3.13 (1.89–5.16; < 0.001), for EN vs. MM of 2.84 (1.62–4.99; P = 0.001), and of 0.91 (0.53–1.56; P = 0.73, i.e., no difference) for PCD vs. MM. Open drainage also had a significantly lower mortality rate than EN, with a ratio of 0.12 (0.02–0.91; < 0.04).Conclusion: the overall mortality rate was ≈18%; shock was associated with a high mortality rate and therefore should be managed aggressively. PCD and MM were associated with significantly higher survival rates than EN, and therefore EN should only be considered if the patient does not improve despite other treatments.
Journal Article, Review
2090-598X
106-115
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Hughes, Owen
6d9b980a-f17d-4974-b456-d13a2821da74
Narahari, Krishna
359c0b67-b054-49ad-ba61-5bacc1afce66
Coulthard, Richard
531af9b8-2e1f-4af0-949f-57897eebd499
Kynaston, Howard
cc327bde-bf3b-4e32-9bdb-da36c76aa4f9
Chlosta, Piotr
922ceecf-17a8-49ca-b484-8c0b5d03e70e
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Hughes, Owen
6d9b980a-f17d-4974-b456-d13a2821da74
Narahari, Krishna
359c0b67-b054-49ad-ba61-5bacc1afce66
Coulthard, Richard
531af9b8-2e1f-4af0-949f-57897eebd499
Kynaston, Howard
cc327bde-bf3b-4e32-9bdb-da36c76aa4f9
Chlosta, Piotr
922ceecf-17a8-49ca-b484-8c0b5d03e70e
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Aboumarzouk, Omar M, Hughes, Owen, Narahari, Krishna, Coulthard, Richard, Kynaston, Howard, Chlosta, Piotr and Somani, Bhaskar (2014) Emphysematous pyelonephritis: time for a management plan with an evidence-based approach. Arab Journal of Urology, 12 (2), 106-115. (doi:10.1016/j.aju.2013.09.005).

Record type: Review

Abstract

Introduction: emphysematous pyelonephritis (EPN) is a life-threatening necrotising kidney infection, but there is no consensus on the best management.Methods: we systematically reviewed previous articles published from 1980 to 2013 that included studies reporting on EPN, and applying the Cochrane guidelines, we conducted a meta-analysis of the results.Results: in all, 32 studies were included, with results for 628 patients (mean age 56.6 years, range 33.8–79.9). There were 462 women, outnumbering men by 3:1. Diabetes was present in 85% of the cases. Fevers and rigor (74.7%), pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was associated with 54.4% of deaths while obstructive uropathy was associated with 15.1% of deaths. Computed tomography was diagnostic in all the cases. Percutaneous drainage (PCD) and medical management (MM) alone were associated with a significantly lower mortality rate than was emergency nephrectomy (EN), with an odds ratio (95% confidence interval) for PCD vs. EN of 3.13 (1.89–5.16; < 0.001), for EN vs. MM of 2.84 (1.62–4.99; P = 0.001), and of 0.91 (0.53–1.56; P = 0.73, i.e., no difference) for PCD vs. MM. Open drainage also had a significantly lower mortality rate than EN, with a ratio of 0.12 (0.02–0.91; < 0.04).Conclusion: the overall mortality rate was ≈18%; shock was associated with a high mortality rate and therefore should be managed aggressively. PCD and MM were associated with significantly higher survival rates than EN, and therefore EN should only be considered if the patient does not improve despite other treatments.

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e-pub ahead of print date: 19 November 2013
Published date: June 2014
Keywords: Journal Article, Review

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Local EPrints ID: 419238
URI: https://eprints.soton.ac.uk/id/eprint/419238
ISSN: 2090-598X
PURE UUID: 576c3aef-4671-4345-891a-8b5691fccad6

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Date deposited: 09 Apr 2018 16:30
Last modified: 16 Sep 2019 17:00

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