기종성 신우신염의 임상양상 및 사망위험인자
Clinical Manifestation of Emphysematous Pyelonephritis and Risk Factors for Mortality
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background : Emphysematous pyelonephritis (EPN) is an acute gas forming necrotizing infection of the renal parenchyma with high mortality. Although its incidence is relatively low, it mostly occurs in patients wiith diabetes mellitus. The aim of the study is to identify the risk factors related to mortality and assess the outcome of managements according to the radiologic classification. Materials and Methods : The clinical records of 23 patients diagnosed with EPN were reviewed retrospectively. The cases were grouped into two types on the basis of computed tomography scan. Type 1 EPN was defined as renal necrosis and gas formation with total absence of fluid content. Type 2 EPN was defined as the presence of renal or perirenal fluid in association with bubbly or loculated gas pattern. The patients' symptoms, performed investigations, and treatments were analyzed. Results : All patients had diabetes mellitus. Escherichia coli (78.6%) was the most common pathogen in urine and blood cultures. The factors showing statistically significant differences between survivors and non-survivors were age (P=0.013), the presence of obstructive uropathy (P= 0.008), and type 1 group (P=0.030). Multivariate logistic regression showed that factor significantly related to death was age (odds ratio=1.20, 95% confidence interval 1.01-1.38, P=0.037). Conservative treatment including antibiotics and percutaneous drainage was successful in type 2 group. Overall mortality was 26.1%; all expired patients were from type 1 group. The mortality of conservative treatment and nephrectomy in type 1 group was 83.3% and 20.0%, respectively. Conclusion : These results suggest that old age is a significant risk factor for mortality in patients with EPN. Nephrectomy should be considered as the main treatment option in patients with type 1 EPN.
Abstract
Background : Emphysematous pyelonephritis (EPN) is an acute gas forming necrotizing infection of the renal parenchyma with high mortality. Although its incidence is relatively low, it mostly occurs in patients wiith diabetes mellitus. The aim of the study is to identify the risk factors related to mortality and assess the outcome of managements according to the radiologic classification. Materials and Methods : The clinical records of 23 patients diagnosed with EPN were reviewed retrospectively. The cases were grouped into two types on the basis of computed tomography scan. Type 1 EPN was defined as renal necrosis and gas formation with total absence of fluid content. Type 2 EPN was defined as the presence of renal or perirenal fluid in association with bubbly or loculated gas pattern. The patients' symptoms, performed investigations, and treatments were analyzed. Results : All patients had diabetes mellitus. Escherichia coli (78.6%) was the most common pathogen in urine and blood cultures. The factors showing statistically significant differences between survivors and non-survivors were age (P=0.013), the presence of obstructive uropathy (P= 0.008), and type 1 group (P=0.030). Multivariate logistic regression showed that factor significantly related to death was age (odds ratio=1.20, 95% confidence interval 1.01-1.38, P=0.037). Conservative treatment including antibiotics and percutaneous drainage was successful in type 2 group. Overall mortality was 26.1%; all expired patients were from type 1 group. The mortality of conservative treatment and nephrectomy in type 1 group was 83.3% and 20.0%, respectively. Conclusion : These results suggest that old age is a significant risk factor for mortality in patients with EPN. Nephrectomy should be considered as the main treatment option in patients with type 1 EPN.
참고문헌 (20)
- Michaeli J, "Emphysematous pyelonephritis", J Urol, 131, pp.203~208 (1984)
- Klein FA, "Emphysematous pyelonephritis: diagnosis and treatment", South Med J, 79, pp.41~46 (1986)
- Al Makadma AS, "An unusual case of pyelonephritis in a paediatric renal transplant recipient", Pediatr Transplant, 9, pp.258~260 (2005)
- Kim DS, "Emphysematous pyelonephritis demonstrated by computed tomography", 1979, 132, pp.287~288
- Chen MT, "Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience", J Urol, 157, pp.1569~1573 (1997)
- Narlawar RS, "Imaging features and guided drainage in emphysematous pyelonephritis: a study of 11 cases", Clin Radiol, 59, pp.192~197 (2004)
- Ramesh J, "Diabetes, fever, and flank pain", Postgrad Med J, 74, pp.241~243 (1998)
- Wan YL, "Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome", Radiology, 198, pp.433~438 (1996)
- Kelly HA, "Pneumaturia", JAMA, 31, pp.375~381 (1898)
- Shokeir AA, "Emphysematous pyelonephritis: a 15-year experience with 20 cases", Urology, 49, pp.343~346 (1997)
- Tang HJ, "Clinical characteristics of emphysematous pyelonephritis", J Microbiol Immunol Infect, 34, pp.125~130 (2001)
- Huang JJ, "Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis", Arch Intern Med, 160, pp.797~805 (2000)
- Ramanathan V, "Successful medical management of recurrent emphysematous pyelonephritis", Urology, 67, pp.623~ (2006)
- Hoddick W, "CT and sonography of severe renal and perirenal infections", AJR Am J Roentgenol, 140, pp.517~520 (1983)
- Dutta P, "Presentation and outcome of emphysematous renal tract disease in patients with diabetes mellitus", Urol Int, 78, pp.13~22 (2007)
- Ahmad M, "Emphysematous renal tract disease due to Aspergillus fumigatus", J Assoc Physicians India, 52, pp.495~497 (2004)
- Wan YL, "Predictors of outcome in emphysematous pyelonephritis", J Urol, 159, pp.369~373 (1998)
- Park BS, "Outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis", Scand J Urol Nephrol, 40, pp.332~338 (2006)
- Angulo JC, "Successful conservative management of emphysematous pyelonephritis, bilateral or in a solitary kidney", Scand J Urol Nephrol, 31, pp.193~197 (1997)
- Gerzof SG, "Computed tomography and ultrasonography for diagnosis and treatment of renal and retroperitoneal abscesses", Urol Clin North Am, 9, pp.185~193 (1982)