A Study on Emphysematous Pyelonephritis Presenting at a Tertiary Care Hospital in South India

Background: An uncommon, severe acute necrotizing kidney infection called emphysematous pyelonephritis (EPN) is characterized by the presence of gas in the renal parenchyma, collecting system, and perirenal tissue. Women are more likely than men to get EPN, and people with diabetes are more susceptible to infection. Escherichia coli is the most common causative pathogen in nearly 70% of the reported EPN cases. A conservative approach with antibiotics, image-guided drainage, and improved imaging modalities is necessary in the management of EPN. Methods: We conducted a Retrospective study for a period of 3 years (2023- 2024) in ESICMC, Kalaburgi, Karnataka. We included all the patients diagnosed with Emphysematous Pyelonephritis as the participants of this study. Data on demographic profile, clinical features, and laboratory investigations, imaging studies, management modalities and outcome of patients were recorded retrospectively. Radiological classification was done based on Huang and Tseng. Results: 21 patients diagnosed with Emphysematous pyelonephritis had a female/male ratio of 4:1 and diabetics were 81%. Fever (86%) was the commonest symptom followed by dysuria & frequency (52%) and flank pain (48%). Renal angle tenderness (71%) was the commonest sign. Among the biochemical abnormalities, we found acute renal dysfunction as 38%, hyperglycemia as 81%, leukocytosis as 71%, and dyselectrolytemia as 43% and thrombocytopenia as 19%. 8 patients (38%) were treated under medical management with antibiotics alone, 8 patients (38%) were treated both medically and with a DJ stent. 2 of them were treated both medically and with ultrasound guided Percutaneous drainage (PCD). 1 patient underwent Percutaneous Nephrolithotomy (PCNL) and 2 patients underwent Nephrectomy. Conclusion: Hence, we conclude that, radiographic diagnosis of emphysematous pyelonephritis is necessary. We recommend for early aggressive medical treatment with Percutaneous Drainage (PCD) and DJ stent and suggest that Nephrectomy should be considered only if patients deteriorate or do not improve on conservative treatment.