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

Aboumarzouk, O.M., Zreik, A., Hughes, O., Narahari, K. ORCID: https://orcid.org/0000-0003-0257-7033, Coulthard, R., Kynaston, H. ORCID: https://orcid.org/0000-0003-1902-9930, Chlosta, P. and Somani, B.K. 2014. 670 Emphysematous pyelonephritis: time for a management plan with an evidence based approach. European Urology Supplements 13 (1) , e670. 10.1016/S1569-9056(14)60660-6

Full text not available from this repository.

Abstract

INTRODUCTION & OBJECTIVES: Emphysematous pyelonephritis (EPN) is a life threatening necrotising infection of the kidney. Despite this, no consensus exists regarding its management, even though, numerous management modalities exists. MATERIAL & METHODS: A systematic review of the literature according to Cochrane guidelines was conducted from 1980 to 2013 including studies reporting on EPN. The outcome measures were the patient demographics, investigation results, symptoms, treatment modality and mortality. A meta-analysis of the results was conducted. RESULTS: Thirty-two studies were included for 628 patients with a mean age of 56.6 (range 33.8-79.9). There were 462 females outnumbering men 3:1. Diabetes was present in 85% of the time. Fevers and Rigours (74.7%), pyuria (78.2%), and pain (70.4%) are the most common symptoms. Shock was associated with 54.4% mortality while obstructive uropathy was associated with 15.1% mortality. CT was diagnostic in 100% of cases. Percutaneous drainage (PCD) and medical management alone (MM) had a significantly less mortality rate than Emergency nephrectomy (EN) (PCD vs. EN: P<0.00001; OR: 3.13, 95% CI: 1.89, 5.16) and (EN vs. MM: P<0.0003; OR: 2.84, 95% CI: 1.62, 4.99). No difference was found between the mortality rates of PCD vs. MM: (P=0.73; OR: 0.91, 95% CI: 0.53, 1.56). Open drainage was also found to have significant less mortality figures than EN (OD vs. EN: P<0.04; OR: 0.12, 95% CI: 0.02, 0.91). However, no significant difference was found when compared to the other treatment modalities. There was significantly higher mortality in severe classes of EPN compare to mild classes. CONCLUSIONS: The overall mortality found was about 18%. Shock is associated with a high mortality rate and therefore should be aggressively managed. PCD and MM were associated with significantly higher survival figures as opposed to EN, and therefore EN should be only considered as a last resort

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Elsevier
ISSN:	1569-9056
Last Modified:	19 Nov 2024 11:00
URI:	https://orca.cardiff.ac.uk/id/eprint/173976

Actions (repository staff only)

Edit Item