Emphysematous pyelonephritis: outcomes with conservative management in a tertiary care center: A cross-sectional observational study.

Dr Juturu  Jayaraju; Dr. Chenna Sai   Krishna; Dr V. Mary  Snygdha

doi:10.51168/sjhrafrica.v7i2.2807

Authors

Dr Juturu Jayaraju Assistant Professor, Department of Urology, A C Subba Reddy Government Medical College & Hospital, Nellore, Andhra Pradesh, India.
Dr. Chenna Sai Krishna Assistant Professor, Department of Urology, A C Subba Reddy Government Medical College & Hospital, Nellore, Andhra Pradesh, India.
Dr V. Mary Snygdha Associate Professor, Department of Obstetrics and Gynecology, A C Subba Reddy Government Medical College & Hospital, Nellore, Andhra Pradesh, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2807

Keywords:

Emphysematous pyelonephritis, Conservative management, Percutaneous nephrostomy, Diabetes mellitus, Computed tomography, Renal salvage, Urosepsis

Abstract

Background:

Emphysematous pyelonephritis is a severe necrotizing infection of the kidney characterized by gas formation within the renal parenchyma, collecting system, or perinephric tissues. Early recognition and renal-preserving treatment have changed the management approach from routine nephrectomy to conservative strategies in selected patients.

Objectives:

To evaluate the clinical profile, radiological severity, treatment pattern, and short-term outcomes of patients with emphysematous pyelonephritis managed initially with conservative therapy in a tertiary care center.

Methods:

This hospital-based observational study was conducted at A C Subba Reddy Government Medical College & Hospital, Dargamitta, Nellore, Andhra Pradesh, India, from April 01, 2026, to April 30, 2026. Thirty-five patients diagnosed with emphysematous pyelonephritis and managed initially with antibiotics, supportive care, glycaemic control, and minimally invasive drainage where indicated were included. Clinical variables, CT classification, management modality, and outcomes were analysed descriptively.

Results:

The mean age was 55.1 ± 10.9 years, and females constituted 62.9% of patients. Diabetes mellitus was present in 85.7%, obstructive uropathy in 40.0%, and hypertension in 37.1%. Fever and flank pain were the commonest symptoms. Class 2 disease was the most frequent CT category. Conservative management was successful in 29 patients, giving a renal salvage rate of 82.9%. Delayed nephrectomy and mortality occurred in three patients each.

Conclusion:

Conservative management achieved favourable outcomes in most patients when combined with early antibiotics, metabolic correction, and timely drainage.

Recommendations:

Early CT-based risk stratification, prompt glycaemic control, urine culture-directed antibiotics, and low-threshold minimally invasive drainage are recommended to improve renal salvage.

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