Role of Minimally Invasive Urological Intervention in Acute Pyelonephritis - A Prospective Study

  • Shivraj Bharath Kumar Assistant Professor, Department of Urology
  • Velmurugan Palaniyandi Assistant Professor, Department of Urology
  • Sriram Krishnamoorthy Professor, Department of Urology
  • Venkat Ramanan Professor, Department of Urology
  • Natarajan Kumaresan Professor, Department of Urology
Keywords: Cystitis, Hydroureteronephrosis, Thrombocytopenia, Ureteric stent, Serum Creatinine

Abstract

Introduction: Acute Pyelonephritis (APN) is an acute bacterial infection of the renal pelvis and parenchyma. The clinical spectrum ranges from mild cystitis to severe Emphysematous Pyelonephritis where there is destruction of the parenchyma with gas formation.
Aim: To analyze factors determining need for Double J stenting in patients with Acute Pyelonephritis and also to study the clinical profile and predisposing factors associated with Acute Pyelonephritis.
Materials and Methods: A prospective study was conducted on 100 patients with pyelonephritis. These patients were subdivided into Group 1 (n=52, who had DJ stenting done) and Group 2 (n=48, who were conservatively managed).
Statistical Analysis: Descriptive statistics frequency analysis and percentage analysis were used for categorical variables and the mean and S.D. was used for continuous variables. To find the significance in categorical data Chi-square test and Fisher’s exact test were used.
Results: Presence of turbid urine is one of the symptoms that needed DJ stenting. Patients with emphysematous pyelonephritis more often needed DJ stenting. Serum creatinine was initially high at presentation in most patients in both groups. However, in Group 2, all patients reached normal nadir levels with conservative management. In group 1, none of them had normal levels reached with conservative measures.
Conclusions: Factors that decided the final outcome included gross pyuria, significant fever spikes despite medication, persistent loin tenderness, persistently high total count despite medication, persistently high serum creatinine, thrombocytopenia, positive blood or urine culture and HbA1c > 9.2%. The presence of 2 or more of the above factors in a patient indicates need for stenting in APN cases.

Author Biographies

Shivraj Bharath Kumar, Assistant Professor, Department of Urology

Chettinad Medical College and Research Institute, Chennai, Tamil Nadu, India

Velmurugan Palaniyandi, Assistant Professor, Department of Urology

Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Sriram Krishnamoorthy, Professor, Department of Urology

Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Venkat Ramanan, Professor, Department of Urology

Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Natarajan Kumaresan, Professor, Department of Urology

Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

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Published
2021-10-05