Impact of demographic parameters and drainage techniques on the prognosis of emphysematous pyelonephritis: A 10-year single-center retrospective study.

Abstract

Objective: To demonstrate the impact of demographic data on the clinical outcomes of patients with emphysematous pyelonephritis (EPN) treated at our center, and to present the results obtained-particularly through the comparison of drainage methods-in the largest patient group possible.

Materials and methods: This retrospective single-center study included 54 EPN patients treated at a tertiary care hospital. Inclusion required symptoms of upper urinary tract infection and gas in the renal parenchyma, collecting system, or perinephric space on abdominal CT. Data on demographics, urinary tract stones, labs, imaging (Huang and Tseng classification), hospital and intensive care unit (ICU) stay, and mortality were analyzed by initial treatment, drainage method, and platelet count. Patients with at least 6 months of follow-up were assessed for infection recurrence, renal function loss, and delayed nephrectomy.

Results: Advanced age was associated with increased ICU need and mortality (respectively p = 0.047, p = 0.039). Diabetes was associated with longer hospital stays compared to those without DM (14 vs. 7.5 days, p = 0.015). Thrombocytopenia was linked to higher rates of non-functioning kidneys (66.7%) and delayed nephrectomy (33.3%). No significant differences in morbidity or mortality were found between drainage methods (percutaneous vs. DJ stent). More male patients had advanced-stage disease, though this did not impact outcomes.

Conclusion: EPN is an emergency urological situation with high rate of mortality. Therefore, early diagnosis and appropriate management are crucial to decrease morbidity and mortality. Patient management approaches can be improved with growing evidence and prospective data with future studies.