Department of Surgery and Department of Urology, Lucknow, Uttar Pradesh, India.
Department of Urology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Saudi J Kidney Dis Transpl. 2021 Nov-Dec;32(6):1646-1654. doi: 10.4103/1319-2442.352425.
Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on the management of EPN. A prospective observational study was conducted at the Department of General Surgery, RML Institute of Medical Sciences, Lucknow, as well as at Eras Lucknow Medical College, Lucknow, from 2015 to 2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with EPN. A total of 76 diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). The mean age of the patients was 58.4 ± 6.5 years. The mean duration of diabetes was 5.3 ± 3.3 years. 12 (82%) of the 15 patients with diabetes mellitus had a glycosylated hemoglobin level higher than 7.5. Renal dysfunction at presentation was seen in 11 (73.3%) patients. Among the unilateral involvement, the left kidney was more affected. Escherichia coli in 11 (73.3%), Klebsiella sp. in one (6.6%), Pseudomonas in one (6.6%), and one each with polymicrobial and fungal urinary tract infection, respectively. Of 15 EPN patients, 13 (86.6 %) survived, and one (6.6 %) expired. Two of them underwent nephrectomy both survived. All patients with Stage I, II, and IIIa EPN (n = 12) were managed with antibiotics with or without percutaneous catheter drainage (PCD). In EPN Stage IIIb/IV (n = 3), all the three (20%) patients were managed with antibiotics and PCD, and later two (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation, and thrombocytopenia were associated with poor outcome in EPN patients (P <0.05) Multiple logistic regression tests showed shock (P = 0.04) and disturbance of consciousness (P = 0.05) on (hospital admission as being the independent factors for poor outcome. EPN in diabetics needs a high index of suspicion, timely diagnosis, and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes.
气肿性肾盂肾炎（EPN）是糖尿病患者中一种罕见但危及生命的急性化脓性肾脏感染。目前对于 EPN 的治疗还没有达成共识。本研究于 2015 年至 2018 年在勒克瑙的 RML 医学科学研究所普通外科以及 Eras Lucknow 医学院进行，旨在探讨糖尿病合并 EPN 患者的临床、微生物特征和治疗结果。共发现 76 例诊断为肾盂肾炎的糖尿病患者，其中 15 例诊断为 EPN（26.3%）。患者的平均年龄为 58.4 ± 6.5 岁。糖尿病的平均病程为 5.3 ± 3.3 年。15 例糖尿病患者中，有 12 例（82%）糖化血红蛋白水平高于 7.5。11 例（73.3%）患者在就诊时存在肾功能不全。单侧受累中，左肾更易受累。11 例（73.3%）为大肠埃希菌感染，1 例（6.6%）为克雷伯菌属感染，1 例（6.6%）为铜绿假单胞菌感染，1 例分别为混合微生物和真菌性尿路感染。15 例 EPN 患者中，13 例（86.6%）存活，1 例（6.6%）死亡。其中 2 例行肾切除术均存活。所有 I 期、II 期和 IIIa 期 EPN 患者（n=12）均接受抗生素治疗，联合或不联合经皮肾造瘘术（PCD）。在 EPN IIIb/IV 期（n=3）患者中，所有 3 例（20%）患者均接受抗生素和 PCD 治疗，随后 2 例（13.3%）需要肾切除术。只有诊断时间、意识改变、就诊时休克和血小板减少与 EPN 患者的不良预后相关（P<0.05）。多因素逻辑回归分析显示，休克（P=0.04）和意识障碍（P=0.05）是不良预后的独立因素。糖尿病合并 EPN 需要高度怀疑，及时诊断，良好的多学科方法，充分的抗生素和手术治疗，以改善患者预后。
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