Emphysematous pyelonephritis: A 10-year experience with 26 cases.
Emphysematous pyelonephritis: A 10-year experience with 26 cases.
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DOI：
10.4103/2230-8210.183475
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发表时间：
2016-07-01
影响因子：
--
通讯作者：
Laway, Bashir Ahmad
中科院分区：
文献类型：
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作者：
Misgar, Raiz Ahmad;Mubarik, Idrees;Laway, Bashir Ahmad
背景技术背景：气肿性肾盂肾炎是一种坏死性感染，导致肾实质、集合系统或肾周组织内产生气体。大多数病例发生在糖尿病（DM）患者中。在EPN中，早期积极的药物治疗可以避免肾切除术。AIMS：本研究的目的是分析EPN患者的特征，包括患者人口统计学、临床表现、诊断调查、微生物学发现、治疗方式和结局，以及预后因素对结局的影响。材料和方法：我们回顾了26例EPN患者的临床、实验室、放射学和微生物学检查结果、治疗和结局。EPN的严重程度按Huang分级进行分级。我们应用报告的预后因素，我们的患者，以了解这些因素是否与保守治疗失败。结果：所有的研究对象有DM和所有，但其中两个是女性。我们的大多数患者（61.5%）有广泛的EPN（3级或4级），大多数（76.9%）有两个或两个以上的不良预后因素。大肠杆菌是最常见的致病微生物涉及我们的情况下，50%。23例（88.5%）保守治疗有效，2例需要肾切除术，1例保守治疗无效。大肠杆菌是最常见的病原体。近三分之一的患者患有双侧疾病。尽管存在两个或两个以上的不良预后因素和广泛的EPN（3级或4级）在我们的大多数患者，保守治疗提供了一个惊人的成功率为88.5%。我们建议早期积极的药物治疗，并建议肾切除术应考虑只有当患者恶化或不改善保守治疗。
BACKGROUND: Emphysematous pyelonephritis (EPN) is a necrotizing infection which results in gas within the renal parenchyma, collecting system, or perinephric tissue. A majority of cases occur in patients with diabetes mellitus (DM). In EPN, early aggressive medical treatment may avoid nephrectomy.AIMS: The aim of this study was to analyze the characteristics of patients with EPN with respect to patient demographics, clinical presentation, diagnostic investigations, microbiological findings, treatment modality and outcome, and the influence of prognostic factors on the outcome.MATERIALS AND METHODS: We reviewed the hospital records of 26 patients with EPN for clinical, laboratory, radiological, and microbiological findings, treatments given, and outcome. The severity of EPN was graded as per the Huang classification. We applied the reported prognostic factors to our patients to find out whether these factors correlated with failure of conservative treatment.RESULTS: All the study subjects had DM and all but two of them were females. The majority of our patients (61.5%) had extensive EPN (class 3 or 4) and majority (76.9%) had two or more bad prognostic factors. Escherichia coli was the most common causative organism involved in 50% of our cases. Twenty-three (88.5%) of our patients responded to conservative treatment, two required nephrectomy, and one expired on conservative treatment.CONCLUSIONS: In this series of patients with EPN, all had DM, nearly all were women, and E. coli was the most frequently isolated pathogen. Nearly a third of our patients had bilateral disease. Despite the presence of two or more bad prognostic factors and extensive EPN (class 3 or 4) in a majority of our patients, conservative treatment afforded a striking success rate of 88.5%. We recommend early aggressive medical treatment and suggest that nephrectomy should be considered only if patients deteriorate or do not improve on conservative treatment.