Abstract:
Emphysematous pyelonephritis (EPN) is a potentially life threatening necrotizing
pyelonephritis due to gas producing organisms. The objective of this study was to see the prognosis of
patients of emphysematous pyelonephritis on conservative management. Methods: A Prospective Case
series study was conducted at tertiary care hospitals of Army, Rawalpindi from Jan 2011 to Nov 2015.
A total of 12 patients were evaluated in the study. All patients were managed conservatively and had
hospital stay of maximum 3 weeks. Results: Of the 12 diagnosed diabetic patients (8 females and 4
males) 1 was class I emphysematous pyelonephritis, 4 were class II, 5 of class III a, 1 class III b and 1
case was of class IV. Fever and flank tenderness were the commonest presenting symptoms. All had
positive renal punch and impaired renal functions. Four patients had thrombocytopenia and one patient
presenting in shock died within 48 hours. All patients were initially managed with a protocol of
aggressive fluid resuscitation, strict blood sugar control and broad spectrum antibiotics. Ultrasound
guided percutaneous nephrostomy was done in seven patients for drainage. All patients responded well
to conservative management except one needing nephrectomy. Conclusion:
