Is conservative management effective in Emphysematous Pyelonephritis

Posted by e-Medical PPT Tuesday, September 4, 2012
Emphysematous pyelonephritis
Acute necrotizing parenchymal and perirenal infection caused by gas forming organisms.
High morbidity & poor prognosis.
 Rate of Nephrectomy: 21-29%
 Mortality rate: 60-75%

Classification according to extent of involvement
Class I       : Renal pelvis
Class II      : Renal parenchyma
Class III
  A: Perinephric tissue
  B: Beyond Gerota’s fascia.
Class IV: Bilateral involvement
          EPN in solitary kidney

Radiological Classification
Type I – Parenchymal destruction, absence of fluid collections and presence of mottled gas (Dry type) – Mortality : 69%
Type II – Renal or perirenal collections with bubbly or loculated gas or gas in collecting system. (Wet type) Mortality : 18%

Risk factors
 Thrombocytopenia
 Acute renal insufficiency
 Low S. Albumin
 Altered mental status
 Shock on presentation
                       
Conservative Management in EPN
Antibiotics
Supportive measures
Stenting / Per-cutaneous drainage
          Indications
 Rising S.Creatinine 
 Hydroureteronephrosis
 Sepsis
 Significant renal or peri-renal collection (Percutaneous drainage)

Conservative management is a safe, effective and feasible treatment option in patients with Emphysematous pyelonephritis.
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