#1144 Emphysematous pyelonephritis: experience in a tertiary care hospital of Bangladesh

Abstract Background and Aims Emphysematous pyelonephritis (EPN) is an acute and severe necrotizing infection involving kidney parenchyma, collecting system and surrounding tissues. The diagnosis is characterized by demonstrating gas in these areas. Risk factors for EPN include diabetes mellitus, obstruction in urinary flow by stone or tumors and immunosuppression. Clinical presentation of EPN is like acute pyelonephritis. Being an uncommon diagnosis, cases are managed differently and the outcome has improved in previous years. This study was planned to enlist the demographic, clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN. Method This was a cross-sectional study, performed at Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh from January 2021 to December 2023. Radiologically confirmed [by computed tomography (CT) scan] EPN cases were included in this study. Patients with recent history of genitourinary intervention and patients having fistula between gut and urinary tract were excluded from the study. Patients’ clinical, laboratory and imaging characteristics and in-hospital outcomes were recorded in case record forms from patients’ clinical notes and/or hospital records, at the time of discharge or death, if were any. Results Total numbers of patients were 16 with 10 females. Their age ranged between 29 and 67 (mean 57) years. Risk factors for EPN included diabetes mellitus (16, 100%) and kidney stones (3, 18.8%). Common presenting features were fever (16, 100%), loin pain (11, 68.8%), vomiting (10, 62.5%) and dysuria (10, 62.5%). All (16, 100%) patients had leukocytosis and uncontrolled blood glucose (HbA1c >7%). Seven (43.8%) patients were complicated by acute kidney injury (AKI), five (31.3%) had hyponatremia and three (18.8%) were complicated by bacteremia. Escherichia coli (11, 68.8%) was the most common urinary isolate. Class 2 EPN (11, 68.8%) was the most prevalent CT class followed by class 3B (3, 18.8%), class 3A (1, 6.3%) and class 4 (bilateral disease) (1, 6.3%). Besides medical management, four (25%) patients required surgery (open drainage in three, open drainage with double J stenting in one). None required nephrectomy. Duration of hospital stay was eight (range 6–11) days and there was no death. Conclusion Female diabetic patients with poor glycemic status were predominant in this EPN cohort. Their common clinical features were fever, loin pain, vomiting and dysuria. Two-fifths of patients had AKI and one-fourth required surgery. Nobody required nephrectomy and there was no mortality in this series.