Acute Pyelonephritis: A Single-center Experience.

Autor:	Umesha, L., Shivaprasad, S. M., Rajiv, E. N., Satish Kumar, M. M., Leelavathy, V., Sreedhara, C. G., Niranjan, M. R.
Předmět:	DIABETES risk factors DIAGNOSIS of escherichia coli diseases KIDNEY stone risk factors STENOSIS MORTALITY risk factors PSEUDOMONAS diseases URETHRA stricture MULTIPLE organ failure BENIGN prostatic hyperplasia KLEBSIELLA infections PROTEUS diseases NEUROGENIC bladder CREATININE CLINICAL pathology ENTEROCOCCUS GLYCOSYLATED hemoglobin HOSPITAL care LENGTH of stay in hospitals HOSPITAL admission & discharge HOSPITAL radiological services LONGITUDINAL method MULTIVARIATE analysis PATIENTS SEX distribution PYELONEPHRITIS STATISTICS IMMUNOCOMPROMISED patients PROGNOSIS DIAGNOSIS DISEASE risk factors HYPERPLASIA
Zdroj:	Indian Journal of Nephrology; Nov/Dec2018, Vol. 28 Issue 6, p454-461, 8p
Abstrakt:	Acute pyelonephritis (APN), although a common clinical entity, still not much is known about the clinical profile in the Indian scenario. We prospectively collected clinical, biochemical, and radiological data of patients hospitalized with a diagnosis of APN from March 2014 to June 2016. A total of 296 cases were included in the study. Mean age was 53.85 ± 9.78 years. Male to females ratio was 1.93:1. Among the risk factors recognized for complicated pyelonephritis (PN), diabetes mellitus (DM) (54.4%) was the most common factor followed by renal calculi (14.4%), benign prostatic hyperplasia (6.7%), immunocompromised state (3.3%), stricture urethra and meatal stenosis (3.3%), and neurogenic bladder (2%). Urinary culture was negative in 153 (51.7%) and positive in 143 patient (48.3%). Most common organism isolated was Escherichia coli (29.7%), followed by Klebsiella pneumoniae (5.4%), pseudomonas (5.4%), Enterococcus (4.4%), and Proteus in 10 (3.4%). Serum creatinine of more than 1.5 mg/dl at admission was seen in 96.3% patients; 40% of them had underlying chronic kidney disease with DM being the most common. Multiorgan dysfunction either at admission or during the course in hospital stay was seen in 31.8% patients. Twelve (2%) had emphysematous PN. Six patients had Class II, 4 had Class III, 1 with Class I, and another with Class IV. A total of 18 deaths were noted (6.1%). Hemoglobin <10 g/dl, serum creatinine at admission >1.5 mg/dl, HbA1c% >10%, and immunosuppression had statistically significant association with the development of multiorgan dysfunction on univariate analysis, but on multivariate analysis, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance. Even with attributable risk of mortality, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance on multivariate analysis. HbA1c% adds to the predictive parameters to recognize at-risk patients to intensify the treatment and avoid complications. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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