A Retrospective Analysis of the Clinical and Radiological Profile of Patients Admitted With Emphysematous Pyelonephritis.

BACKGROUND

Emphysematous pyelonephritis (EPN) is a potentially fatal infection of the kidney, predominantly affecting diabetic patients. Despite advances in management, predictors of mortality remain incompletely understood. Analysing the factors associated with a high risk of death can help in identifying high-risk EPN patients and initiating early, aggressive therapy. This study was conducted with the aim of understanding and describing the clinical, biochemical, and microbiological profile of patients diagnosed with EPN and analysing the factors influencing mortality.

METHODS

A retrospective observational study was conducted at Kasturba Hospital, Manipal (2017-2022). Data from 117 EPN patients were collected and analysed for demographic, clinical, laboratory, microbiological, and radiological characteristics. Primary endpoints used were successful treatment and all-cause mortality to assess markers of mortality. Risk factors for mortality were assessed using independent samples t-tests. Statistical significance was set at p<0.05.

RESULTS

A total of 117 patients were included in our study. The mean age was 55.5 years, with a female predominance (56.4%). The most common symptom reported was flank pain (77.8%). Diabetes mellitus (DM) was the most common risk factor identified in 96.6% of patients, and Escherichia coli (E. coli) was the most common isolated organism (54.7%). Most patients had Class 1 (33.3%) and Class 2 (28.2%) disease. The average duration of inpatient treatment was reported to be 17.25 days in our patients. Treatment included antibiotics (94%) and drainage procedures, including DJ stenting (55%). Of the 117 patients, mortality occurred in seven patients (6%). Elevated serum creatinine at admission was significantly associated with mortality (p=0.004), while other laboratory markers (hemoglobin A1c (HbA1c), total leukocyte count (TLC), platelet count, sodium) did not show a significant correlation.

CONCLUSION

Serum creatinine at admission emerged as a key predictor of mortality in EPN, emphasizing the need for early renal function assessment and close monitoring in high-risk patients. The low mortality rate observed in our cohort suggests that early intervention combining empirical antibiotic therapy guided by resistance patterns and minimally invasive drainage techniques may improve survival. Future prospective studies are needed to validate these findings and refine EPN management strategies.