2Emphysematous 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%
3AIMTo analyze the efficacy of conservative management in EPN.
4Methods 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:
5Classification 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
6Radiological 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
7Risk factors Thrombocytopenia Acute renal insufficiency Low S. Albumin Altered mental statusShock on presentationAUA, 2005More than 2 risk factors – Poorer prognosis
8Conservative Management in EPN AntibioticsSupportive measuresStenting / Per-cutaneous drainageIndicationsRising S.CreatinineHydroureteronephrosisSepsisSignificant renal or peri-renal collection (Percutaneous drainage)
9Results Total # of patients : 18 Male : Female : 1: 2 (6 M, 12 F) Age : yrs (mean 51).