Failure of conservative management in emphysematous pyelonephritis

As demonstrated in a case series from Tunisia, thrombocytopenia was the main factor associated with risk of failure of conservative management in emphysematous pyelonephritis [1].

Emphysematous pyelonephritis is a serious condition with significant mortality. However, mortality rates have declined with prompt and aggressive medical management and minimally invasive strategies. The management of this condition is either conservative, consisting of antibiotic therapy alone or in combination with urinary tract drainage, or radical based on a salvage nephrectomy.

The current retrospective study from Tunisia aimed to identify factors associated with failure of conservative management. Patients who were diagnosed with emphysematous pyelonephritis between 2010 and 2020 were retrospectively reviewed. All patients were conservatively managed, and a nephrectomy was performed when the conservative policy failed. Included were 52 patients with a mean age of 58.63 years. Diabetes mellitus was present in 38 patients (73%). The mean presentation delay was approximately 6 days. The distribution of the 4 classes of emphysematous pyelonephritis was: class 1, n=23; class 2, n=11; class 3, n=8; and class 4, n=10.

Dr Ahmed Saadi (University of Tunis, Tunesia) and colleagues found 32 cases of severe sepsis (61.5%) and 9 patients (17.3%) developed a septic shock; 6 patients presented with a septic shock refractory to conservative management, requiring nephrectomy with a delay of almost 5 days, and 2 patients died (3.84%).

A univariate analysis demonstrated that only thrombocytopenia was associated with a significantly higher risk of failure of conservative management and emergent nephrectomy (P=0.015). Consequently, nephrectomy should be considered in extensive forms with refractory septic shock or in case of severe thrombocytopenia.

1. Saadi A, et al. Predictive factors of failure of conservative management in patients with emphysematous pyelonephritis. P0158, EAU21 Virtual, 8–12 July 2021.

 

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Posted on 31 August 2021