Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection, predominantly affecting diabetic and immunocompromised patients. It carries high morbidity and mortality, requiring early diagnosis and timely intervention. Various prognostic scoring systems help in triaging critically ill patients. The National Early Warning Score 2 (NEWS 2) scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters, but its standard form lacks specificity for risk stratification in EPN, necessitating modifications to improve treatment decision-making and prognostic accuracy in this critical condition.

To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.

This prospective study was done on all EPN patients admitted to our hospital over the past 12 years. A weighted average risk-stratification index was calculated for each of the three groups, mortality risk was calculated for each of the NEWS 2 scores, and the need for intervention for each of the three groups was calculated. The NEWS 2 score was subsequently modified with 0-6, 7-14 and 15-20 scores included in groups 1, 2 and 3, respectively.

A total of 171 patients with EPN were included in the study, with a predominant association with diabetes (90.6%) and a female-to-male ratio of 1.5:1. The combined prognostic scoring of the three groups was 10.7, 13.0, and 21.9, respectively (P < 0.01). All patients managed conservatively belonged to group 1 (P < 0.01). Eight patients underwent early nephrectomy, with six from group 3 (P < 0.01). Overall mortality was 8 (4.7%), with seven from group 3 (87.5%). The cutoff NEWS 2 score for mortality was identified to be 15, with a sensitivity of 87.5%, specificity of 96.9%, and an overall accuracy rate of 96.5%. The area under the curve to predict mortality based on the NEWS 2 score was 0.98, with a confidence interval of (0.97, 1.0) and P < 0.001.

Modified NEWS 2 (mNEWS 2) score dramatically aids in the appropriate assessment of treatment-related outcomes. MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.

• Pyelonephritis
• Emphysematous
• Nephrectomy
• National Early Warning Score 2
• Mortality

• PROM
• UTI
• atlas
• infection
• nomograms
• review
• sepsis

• Raoultella ornithinolytica
• Case report
• Diabetes
• Emphysematous pyelonephritis
• Infection

• Humans
• Pyelonephritis/microbiology
• Pyelonephritis/complications
• Male
• Aged, 80 and over
• Emphysema/microbiology
• Enterobacteriaceae Infections/complications
• Enterobacteriaceae Infections/microbiology
• Enterobacteriaceae Infections/drug therapy
• Enterobacteriaceae Infections/diagnosis
• Enterobacteriaceae/isolation & purification
• Anti-Bacterial Agents/therapeutic use

• ER (emergency room)
• Emphysematous pyelonephritis (EPN)
• diabetes mellitus (DM)
• haemoglobin (Hb)
• hydroureteronephrosis (HUN)
• hypertension (HTN)
• intensive care unit (ICU)
• percutaneous drainage (PCD)
• random blood sugar (RBS)
• total leucocyte count (TLC)

• Emphysematous pyelonephritis
• Mortality
• Prognosis

• Complications
• Emphysematous pyelonephritis
• Mortality
• Prognosis
• Scoring system
• Sepsis

• Humans
• Middle Aged
• Critical Care
• Hospital Mortality
• Intensive Care Units
• Prognosis
• Pyelonephritis/complications
• Pyelonephritis/diagnosis
• Retrospective Studies
• ROC Curve
• Sepsis/complications
• Systemic Inflammatory Response Syndrome/diagnosis

• Mortality in Emergency Department Sepsis (MEDS) score
• National Early Warning Score (NEWS)
• Rapid Emergency Medicine Score (REMS)
• emphysematous pyelonephritis (EPN)
• receiver operating characteristic curve (ROC)
• scoring systems

• emphysematous pyelonephritis
• extended-spectrum beta-lactamases
• minimally invasive procedures
• nephrectomy
• prognosis

Background

The study aimed to determine the various indications for percutaneous nephrostomy (PCN) primarily in patients with a urinary tract infection and to determine the various complications arising in these patients due to the procedure.

Materials and methods

A retrospective study of five-year data based on registers of the Department of Urology was performed. Among 716 patients, 226 inpatient data were obtained, curated, and analyzed. Indications for PCN, the periprocedural complications, the PCN's duration, details of antibiotics, risk factors for UTI, development of acute kidney injury, and renal replacement therapy were recorded.

Results

Patients were mostly female (53.1%, n=120/226). Malignancy (n=109, carcinoma cervix=68/109) and nephrolithiasis (n=70) contributed to 79.2%. Infections such as pyelonephritis, renal abscess, perinephric abscess, and genitourinary tuberculosis were identified in 47. Infectious diseases were significantly associated with younger age, female gender, diabetes, and prior pyelonephritis. PCN was placed at a median of two days after admission, and bilateral PCN was placed in 36 (15.2%) patients. Hydroureteronephrosis (probably infected) was an indication for PCN in 164/226 patients. In 33 patients with an infectious disease, PCN was performed for an obstructed urinary system. One major and two minor complications gave a rate of 0.06% for patients with infections, which was less than the accepted threshold of 4%.

Conclusions

We intended to study the utility and problems with placing a PCN catheter in patients with complicated urinary infections. We conclude that PCN is a safe and effective procedure in urinary tract infections with obstructed drainage.

Emphysematous pyelonephritis (EPN) is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma, collecting system, or perinephric tissue and has a poor prognosis. EPN occurs primarily in people with diabetes mellitus (DM), but can occur in those without DM when the associated renoureteral unit is obstructed.

We describe our experience with six patients who developed EPN. Five patients had DM, including one with diabetic ketoacidosis, one with multisystem involvements, including eye, lung and brain. Bilateral urolithiasis was present in one case, along with emphysematous cystitis. Unilateral kidney stones were present in one patient. One patient was an older man in poor general health. Five individuals survived and underwent surgical procedures including ureteral stent installation (Double J stent placement), percutaneous nephrostomy and perinephric abscess puncture drainage, while one died because the patient’s family chose to terminate therapy. Klebsiella pneumoniae and Escherichia coli were the microorganisms implicated.

We conclude that EPN is a potentially fatal illness. A positive outcome necessitates early detection. Therapeutic measures should be implemented as soon as a diagnosis is made.

• Emphysematous pyelonephritis
• Urinary tract infection
• Classification
• Gram-negative facultative anaerobic bacteria
• Case report

• Emphysematous cystitis
• Emphysematous pyelonephritis
• Necrotizing infection