Mortality in emphysematous pyelonephritis: Can we reduce it further by using a protocol-based treatment? The results of a prospective study

INTRODUCTION: Even though the mortality rate in emphysematous pyelonephritis (EPN) is brought down presently to 13%–25%, there is still scope for improvement. The hurdle lies in identifying those patients at risk of mortality earlier in the disease process and providing intensive management to them. In this study, we created risk groups by combining both clinical and radiological presentations and applied a protocol-based treatment to evaluate its role in reducing mortality. METHODS: We formulated a treatment protocol based on the available literature. The first step was to recruit all patients diagnosed with EPN into the treatment protocol as soon as possible without any delay. The second step was to stratify the patients into risk groups based on our clinicoradiological risk group classification. The third step was to apply the treatment protocol according to the risk group they belonged to. RESULTS: We treated 24 patients with EPN in the past 4 years. According to the radiological classification – four patients had Type 1 disease, five patients had Type 2A disease, six patients had Type 2B disease, four patients had Type 3A disease, two patients had Type 3B disease, two patients had Type 4A disease, and one patient had 4B disease. Following risk stratification, we have categorized seven patients into category 1, eight patients into category 2, and nine patients into category 3. All except one patient survived following the treatment protocol followed by us. CONCLUSIONS: Early risk stratification, intensive management, and prompt treatment according to a protocol can reduce mortality even further in patients with EPN.