Kidney preservation protocol for management of emphysematous pyelonephritis:
Treatment modalities and follow-up
#MMPMID26579294
El-Nahas AR
; Shokeir AA
; Eziyi AK
; Barakat TS
; Tijani KH
; El-Diasty T
; Abol-Enein H
Arab J Urol
2011[Sep]; 9
(3
): 185-9
PMID26579294
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OBJECTIVES: To present treatments for kidney preservation in the management of
emphysematous pyelonephritis (EPN), and to evaluate the functional outcome of
preserved kidneys during the follow-up. PATIENTS AND METHODS: The computerized
files of patients with EPN from 2000 to 2010 were reviewed. After initial
resuscitation, ultrasonography-guided percutaneous tubes were placed for drainage
of infected fluid and gas. A radio-isotopic renal scan was done after
stabilization of the patients' condition. Preservation of the affected kidney was
attempted when the differential function was >10%. A renal isotopic scan was
taken during the follow-up to evaluate renographic changes in preserved kidneys.
RESULTS: The study included 33 kidneys in 30 consecutive patients (mean age
51.7 years, SD 10.9). Kidney preservation was applicable for 23 kidneys (20
patients). Preservation methods included percutaneous nephrostomy for 12,
percutaneous tube drain for two and conservative treatment for nine kidneys (six
patients). Nephrectomy was performed for 10 kidneys (emergency in three and
delayed in seven). The frequency of post-treatment septic shock after kidney
preservation (10%) was significantly lower than after nephrectomy (20%,
P = 0.005). The overall mortality rate was 7% (two patients). The follow-up was
completed for 13 patients with 15 preserved kidneys for a mean duration of
21 months. During the follow-up, differential renographic clearance of the
affected kidney was stable in 13 of 15 while two kidneys showed improvement.
CONCLUSIONS: Kidney preservation should be the primary goal in the treatment of
EPN when the differential renal clearance is >10%. It was associated with fewer
complications than nephrectomy and the follow-up showed a favourable functional
outcome of the preserved kidneys.
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