Clinical characteristics and prognostic factors of emphysematous pyelonephritis: a therapeutic experience at a tertiary care hospital center in Mexico

Abstract

Introduction: Emphysematous pyelonephritis (EP) is a necrotizing infection of the upper urinary tract, associated with enterobacteria, whose progression is subacute and insidious. Diagnosis is clinical and is corroborated and staged through computed tomography. Management depends on the severity of the case and can range from antimicrobial therapy and surveillance to emergency nephrectomy.

Aim: To describe the factors associated with the severity of EP in a population seen at the Urology Service of the Hospital General de México.

Materials and methods: A retrospective, observational, analytic study was conducted. The qualitative variables were expressed through simple frequencies and percentage distribution and the quantitative variables were expressed through measures of central tendency. The variables with non-normal distribution were expressed through median and interquartile range. Group comparisons were carried out using the Fisher’s exact test (qualitative variables), the Mann-Whitney U test, and 95% confidence intervals (95% CIs). Odds ratios (ORs) were utilized for the inferential statistics to obtain the relation of each factor to severity. Calculations were made with a 95% CI and a 5% alpha error.  

Results: The factors associated with EP severity were: bilaterality (OR 7.5, 95% CI 1.56-36.8, p 0.011), renal colic (OR 2.9, 95% CI 0.70-12.4, p 0.01), leukocytosis (OR 1.5, 95% CI 0.44-4.92, p 0.04), thrombocytopenia (OR 3.2, 95% CI 0.29-34.7, p 0.04), Glasgow coma score < 15 (OR 1.3, 95% CI 0.31-3.39, p 0.001), and azotemia (OR 1.5, 95% CI 0.44-4.92, p 0.04).

Conclusion: The early identification of those factors can reduce the risk for complications and improve disease progression in patients with EP.