Clinical characteristics and risk factors for septic shock in patients receiving emergency drainage for acute pyelonephritis with upper urinary tract calculi

Yoshiyuki Yamamoto, Kazutoshi Fujita, Shigeaki Nakazawa, Takuji Hayashi, Go Tanigawa, Ryoichi Imamura, Masahiro Hosomi, Daiki Wada, Satoshi Fujimi, Seiji Yamaguchi, Yoshiyuki Yamamoto, Kazutoshi Fujita, Shigeaki Nakazawa, Takuji Hayashi, Go Tanigawa, Ryoichi Imamura, Masahiro Hosomi, Daiki Wada, Satoshi Fujimi, Seiji Yamaguchi

Abstract

Background: Acute pyelonephritis (APN) is a common complication of ureteral obstruction caused by urolithiasis, and it can be lethal if it progresses to septic shock. We investigated the clinical characteristics of patients undergoing emergency drainage and assessed risk factors for septic shock.

Methods: A retrospective study was performed of 98 patients (101 events) requiring emergency drainage at our urology department for obstructive APN associated with upper urinary tract calculi from January 2003 to January 2011. Clinical characteristics were summarized, and risk factors for septic shock were assessed by logistic regression analysis.

Results: Objective evidence of sepsis was found in 64 (63.4%) events, and 21 events (20.8%) were categorized as septic shock. Ninety-six patients recovered, but 2 patients died of septic shock. Multivariate analysis revealed that age and the presence of paralysis were independent risk factors for septic shock.

Conclusions: APN associated with upper urinary tract calculi is a severe disease that should be treated with caution, particularly when risk factors are present.

References

    1. Hsu CY, Fang HC, Chou KJ, Chen CL, Lee PT, Chung HM. The clinical impact of bacteremia in complicated acute pyelonephritis. Am J Med Sci. 2006;332:175–180. doi: 10.1097/00000441-200610000-00004.
    1. Yoshimura K, Utsunomiya N, Ichioka K, Ueda N, Matsui Y, Terai A. Emergency drainage for urosepsis associated with upper urinary tract calculi. J urol. 2005;173:458–462. doi: 10.1097/.
    1. Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet. 2005;365:63–78. doi: 10.1016/S0140-6736(04)17667-8.
    1. Wagenlehner FM, Weidner W, Naber KG. Optimal management of urosepsis from the urological perspective. Int J Antimicrob Agents. 2007;30:390–397. doi: 10.1016/j.ijantimicag.2007.06.027.
    1. Comarr AE, Kawaichi GK, Bors E. Renal calculosis of patients with traumatic cord lesions. J Urol. 1962;87:647–656.
    1. Angulo JC, Gaspar MJ, Rodríguez N, García-Tello A, Torres G, Núñez C. The value of C-reactive protein determination in patients with renal colic to decide urgent urinary diversion. Urology. 2010;76:301–306. doi: 10.1016/j.urology.2009.12.002.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel