Acute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi.
We retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis.
Overall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock.
Patients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.
Takahashi S, Kurimura Y, Takeyama K, Hashimoto K, Miyamoto S, Ichihara K, Igarashi M, Hashimoto J, Furuya R, Hotta H, Uchida K, Miyao N, Yanase M, Takagi Y, Tachiki H, Taguchi K, Tsukamoto T (2009) Efficacy of treatment with carbapenems and third generation cephalosporins for patients with febrile complicated pyelonephritis. J Infect Chemother 15:390–395 PubMedCrossRef
Clark SR, Ma AC, Tavener SA, McDonald B, Goodarzi Z, Kelly MM, Patel KD, Chakrabarti S, McAvoy E, Sinclair GD, Keys EM, Allen-Vercoe E, DeVinney R, Doig CJ, Green FHY, Kubes P (2007) Platelet TLR4 activates neutrophil extracellular traps to ensnare bacteria in septic blood. Nat Med 13:463–469 PubMedCrossRef
Stohlawetz P, Folman CC, von dem Borne AE, Pernerstorfer T, Eichler HG, Panzer S, Jilma B (1999) Effects of endotoxemia on thrombopoiesis in men. Thromb Haemost 81:613–617 PubMed
Ruot B, Breuille D, Rambourdin F, Bayle G, Capitan P, Obled C (2000) Synthesis rate of plasma albumin is a good indicator of liver albumin synthesis in sepsis. Am J Physiol Endocrinol Metab 279:E244–E251 PubMed
Yamamoto Y, Fujita K, Nakagawa S, Hayashi T, Tanigawa G, Imamura R, Hosomi M, Wada D, Fujimi S, Yamaguchi S (2012) Clinical characteristics and risk factors for septic shock in patients receiving emergency drainage for acute pyelonephritis with upper urinary tract calculi. BMC Urol 12:4 PubMedCentralPubMedCrossRef
- Predictors of septic shock in obstructive acute pyelonephritis
- Springer Berlin Heidelberg
Neu im Fachgebiet Urologie
Meistgelesene Bücher in der Urologie
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