Presentation on theme: "Is conservative management effective in Emphysematous Pyelonephritis?"— Presentation transcript:
1 Is conservative management effective in Emphysematous Pyelonephritis? Vijay Anand, Vineet, Sridharan, Venkat Ramanan,Sunil Shroff, M.G.Rajamanickam.Department of Urology & Renal transplantation,SRMC & RI.
2 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%
3 AIMTo analyze the efficacy of conservative management in EPN.
4 Methods Retrospective study Inclusion criteria: All patients of EPN managed in our centre in the last three years.Diagnosis of EPN: Based on clinical and radiological findingsThe risk factors and classification done based on study by Wan et al *Correlation between imaging finding & clinical outcome ; Liang Wan, Tze u lee ;Radiology 1996; 198:
5 Classification according to extent of involvement Class I : Renal pelvisClass II : Renal parenchymaClass IIIA : Perinephric tissueB : Beyond Gerota’s fascia.Class IV : Bilateral involvement EPN in solitary kidney
6 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%Wan et al 1996, Best et al 1999
7 Risk factors Thrombocytopenia Acute renal insufficiency Low S. Albumin Altered mental statusShock on presentationAUA, 2005More than 2 risk factors – Poorer prognosis
8 Conservative Management in EPN AntibioticsSupportive measuresStenting / Per-cutaneous drainageIndicationsRising S.CreatinineHydroureteronephrosisSepsisSignificant renal or peri-renal collection (Percutaneous drainage)
9 Results Total # of patients : 18 Male : Female : 1: 2 (6 M, 12 F) Age : yrs (mean 51).