کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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6167723 | 1250328 | 2014 | 5 صفحه PDF | دانلود رایگان |
ObjectiveTo analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality.MethodsWe retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality.ResultsA total of 62 patients were included (49 women and 13 men), with a mean age of 53.9Â years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (PÂ = .06). Survivors were younger (PÂ = .004), had lower creatinine (PÂ = .002), and better estimated glomerular filtration rate (PÂ = .007). In univariate analysis, age (PÂ = .009), creatinine (PÂ = .009), and need for nephrectomy (PÂ = .03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, PÂ = .03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, PÂ = .049) remained significant predictors of mortality.ConclusionEPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.
Journal: Urology - Volume 83, Issue 6, June 2014, Pages 1280-1284