Abstract

THROMBOCYTOPENIA AS A PREDICTOR OF ACUTE KIDNEY INJURY & LENGTH OF HOSPITAL STAY IN PATIENTS WITH EMPHYSEMATOUS PYELONEPHRITIS

Dr. Sanjay Ramachandra Pudakalkatti, Dr. Rajendra Prasad K. N.*, Dr. Anvesh A., Dr. Shivalingaiah Maregowda and Dr. Keshavmurthy Ramaiah

ABSTRACT

Introduction: Emphysematous pyelonephritis is a urologic emergency, defined as a necrotic infection of the kidney characterized by production of air in the renal collecting system, parenchyma, and perinephric tissue. Thrombocytopenia is an important predictor for development of acute kidney injury in patients with emphysematous pyelonephritis. Objective: The aim of this study was to assess the relationship between thrombocytopenia and acute kidney injury in patients with emphysematous pyelonephritis and also to determine their length of hospital stay. Methods: Our study is a retrospective study of 227 emphysematous pyelonephritis patients. The data was collected in Institution of Nephro- Urology for 11 years from January 2007 to December 2018. The parameters assessed were age, gender, clinical features, imaging results, urine culture, platelet count, serum creatinine, blood urea nitrogen & length of hospital stay. All patients above the age of 18 years with CT confirmed diagnosis of EPN were included in our study. Patients with history of urethral drainage/instrumentation, urethral fistula, urethral trauma, end stage renal disease were excluded from our study. Pearson analysis was used to correlate and all analyses were performed using the SPSS statistical software (IBM SPSS statistics, version 22.0) Results: Out of 227 patient studied 154 patients(67.8%) developed acute kidney injury. Mean age group affected was 52.22. Most common presenting symptoms were fever (98.23%) and loin pain (68.28%). Incidence of thrombocytopenia in patients who developed AKI was observed in 90 patients(58%). Mean length of hospital stay in patients with AKI with thrombocytopenia is 7.1 days. In our study, the platelet count was negatively associated with peak serum creatinine (r=-0.476, P< 0.001), peak BUN (r=-0.314, P<0.001) and length of hospital stay (r=-0.462, P=<0.001). Platelet count was inversely related to serum creatinine, peak BUN, length of hospital stay and is statistically significant. Thrombocytopenia and length of hospital stay has been independently correlated with the development of AKI in patients with EPN. Conclusion: Thrombocytopenia is a significant predictor of development of acute kidney injury in EPN patients. Length of hospital stay was significantly higher in EPN patients with thrombocytopenia.

Keywords: Thrombocytopenia, acute kidney injury, emphysematous pyelonephritis.