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논문분류	춘계학술대회 초록집
제목	Clinical determinants for optimal treatment for emphysematous pyelonephritis
저자	Dong Eon Kim
출판정보	2024; 2024(1):
키워드
초록	Objectives: Emphysematous pyelonephritis (EPN) is an acute necrotizing gas-forming infection of the kidney and perinephric area that leads to a poor prognosis. To achieve better clinical outcomes with minimally invasive approach, it is important to understand the factors influencing the successful conservative treatment. Methods: Demographic data, laboratory data, clinical data, and radiologic classifications by Huang and Tseng were collected from 39 patients at a tertiary hospital. We defined conservative treatment as the use of antibiotics with or without percutaneous nephrostomy (PCN). The primary outcome was the conservative treatment failure, defined as either nephrectomy or death. Results: The mean age was 66.2 ± 2.3 years and 26 (66.7%) patients were female. The most common comorbidity was diabetes (69.2%), followed by hypertension (51.3%) and urolithiasis (35.9%). Isolated pathogens were Escherichia coli (N = 26, 66.7%), Klebsiella pneumoniae (N = 10, 25.6%), Pseudomonas aeruginosa (N = 2, 5.1%), and Proteus mirabilis (N = 1, 2.5%). The radiologic classification system categorized the patients as follows: Class I (N = 9, 23.0%), Class II (N = 14, 35.9%), Class IIIa (N = 3, 7.6%), Class IIIb (N = 8, 20.5%), and Class IV (N = 5, 12.8%). Overall mortality rate was 18% (N = 7, 18%). All patients received broad-spectrum antibiotics at admission and 27 patients (69.2%) received PCN in the early period (< 24h). Six patients (22.2%) who received PCN subsequently required nephrectomy. Another two patients underwent emergent nephrectomy without PCN. Multivariable analysis showed that higher grading of radiologic classification (OR: 2.16, 95% CI: 1.145-4.290, p=0.018) and hypoalbuminemia (< 3.0 mg/dL, OR: 7.169, 95% CI: 1.339-38.370, p=0.021) were associated with conservative treatment failure. Conclusions: Conservative treatment may be not suitable for EPN patients with higher grade of radiologic classification and hypoalbuminemia.
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