Evaluation of therapeutic outcomes in emphysematous pyelonephritis: a single-center experience at Siriraj Hospital

Objective: Emphysematous pyelonephritis (EPN) is an acute, severe, necrotizing parenchymal and perirenal infection associated with high morbidity and mortality. The radiographic classifications, which determine the treatment strategies, however, remain controversial. Our study aimed to evaluate and compare the clinical parameters related to nephrectomy and the treatment outcomes in current practices. Materials and Methods: We retrospectively reviewed the data from 21 EPN patients who had been diagnosed using computed tomography (CT) scans, who were admitted to Siriraj Hospital from January 2009 to December 2019. The clinical manifestations, imaging results, laboratory findings, treatment methods, and overall outcomes of each patient were reviewed and analyzed. Huang–Tseng’s and Wan’s classifications were used to classify the images obtained from the CT scans. Results: Among the 21 patients with EPN, all had at least one comorbidity associated with a compromised immune response. Common manifestations included fever (74%) and initial laboratory findings showed hyperglycemia (66%), acute kidney injury (72%), and metabolic acidosis (76%). Inotropes were used in 13 patients for hemodynamic support. Eleven patients were treated with a non-nephrectomy approach, while 10 patients underwent nephrectomy. No statistical difference in treatment outcomes was observed between groups in both classification systems. Overall survival was 100% with a minimum one-year follow-up. Conclusion: Our study demonstrated that the current treatment approach has resulted in a zero mortality rate of EPN most probably due to advancements in antibiotics, surgical techniques, and postoperative intensive care over the years. However, refining treatment strategies, considering radiographic criteria, clinical parameters, and initial treatment response, is essential in future studies to further decrease disease morbidity.