Umesha L, Shivaprasad S M, Rajiv E N, Kumar M M Satish, Leelavathy V, Sreedhara C G, Niranjan M R
Department of Nephrology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru, Karnataka, India.
Indian J Nephrol. 2018 Nov-Dec;28(6):454-461. doi: 10.4103/ijn.IJN_219_16.
Acute pyelonephritis (APN), although a common clinical entity, still not much is known about the clinical profile in the Indian scenario. We prospectively collected clinical, biochemical, and radiological data of patients hospitalized with a diagnosis of APN from March 2014 to June 2016. A total of 296 cases were included in the study. Mean age was 53.85 ± 9.78 years. Male to females ratio was 1.93:1. Among the risk factors recognized for complicated pyelonephritis (PN), diabetes mellitus (DM) (54.4%) was the most common factor followed by renal calculi (14.4%), benign prostatic hyperplasia (6.7%), immunocompromised state (3.3%), stricture urethra and meatal stenosis (3.3%), and neurogenic bladder (2%). Urinary culture was negative in 153 (51.7%) and positive in 143 patient (48.3%). Most common organism isolated was (29.7%), followed by (5.4%), (5.4%), (4.4%), and Proteus in 10 (3.4%). Serum creatinine of more than 1.5 mg/dl at admission was seen in 96.3% patients; 40% of them had underlying chronic kidney disease with DM being the most common. Multiorgan dysfunction either at admission or during the course in hospital stay was seen in 31.8% patients. Twelve (2%) had emphysematous PN. Six patients had Class II, 4 had Class III, 1 with Class I, and another with Class IV. A total of 18 deaths were noted (6.1%). Hemoglobin <10 g/dl, serum creatinine at admission >1.5 mg/dl, HbA1c% >10%, and immunosuppression had statistically significant association with the development of multiorgan dysfunction on univariate analysis, but on multivariate analysis, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance. Even with attributable risk of mortality, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance on multivariate analysis. HbA1c% adds to the predictive parameters to recognize at-risk patients to intensify the treatment and avoid complications.
急性肾盂肾炎（APN）虽是一种常见的临床病症，但在印度背景下，对其临床特征仍知之甚少。我们前瞻性地收集了2014年3月至2016年6月期间因诊断为APN而住院患者的临床、生化和放射学数据。该研究共纳入296例病例。平均年龄为53.85±9.78岁。男女比例为1.93:1。在已确认的复杂性肾盂肾炎（PN）的危险因素中，糖尿病（DM）（54.4%）是最常见的因素，其次是肾结石（14.4%）、良性前列腺增生（6.7%）、免疫功能低下状态（3.3%）、尿道狭窄和尿道口狭窄（3.3%）以及神经源性膀胱（2%）。153例（51.7%）患者的尿培养结果为阴性，143例患者（48.3%）为阳性。分离出的最常见病原体为[具体病原体未给出]（29.7%），其次是[具体病原体未给出]（5.4%）、[具体病原体未给出]（5.4%）、[具体病原体未给出]（4.4%），10例（3.4%）为变形杆菌。96.3%的患者入院时血清肌酐超过1.5mg/dl；其中40%患有潜在的慢性肾脏病，最常见的病因是DM。31.8%的患者在入院时或住院期间出现多器官功能障碍。12例（2%）患有气肿性PN。6例为II级，4例为III级，1例为I级，另1例为IV级。共记录到18例死亡（6.1%）。单因素分析显示，血红蛋白<10g/dl、入院时血清肌酐>1.5mg/dl、糖化血红蛋白（HbA1c）%>10%以及免疫抑制与多器官功能障碍的发生有统计学显著关联，但多因素分析显示，只有血红蛋白、HbA1c%和免疫抑制达到统计学显著水平。即使在死亡率的归因风险方面，多因素分析中只有血红蛋白、HbA1c%和免疫抑制达到统计学显著水平。HbA1c%增加了预测参数，以识别高危患者，加强治疗并避免并发症。
