Document Detail


Emergency nephrectomy due to severe urosepsis: a retrospective, multicentre analysis of 65 cases.
MedLine Citation:
PMID:  19338556     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the outcome of emergency nephrectomy in a retrospective, multicentre analysis, as emergency nephrectomy due to life-threatening urosepsis is a rare clinical scenario with a high mortality, and there are few reports of clinical data on this issue. PATIENTS AND METHODS: We assessed retrospectively all patients who had a nephrectomy due to life-threatening urosepsis in three referral centres in Vienna between 1994 and 2007. Patient characteristics, survival and risk factors for a fatal outcome were evaluated. RESULTS: In all 65 patients (44 women and 21 men; mean age 65 years) were analysed. The mean interval from the first medical consultation to hospital admission was 4.3 days. Two-thirds of patients were admitted directly from their homes (63%), the remainder being transferred from other departments or hospitals. The most common pathological mechanism leading to urosepsis was acute pyelonephritis, often combined with nephrolithiasis. In all, 36 patients had a urological intervention before nephrectomy, i.e. percutaneous nephrostomy in 17, ureteric stent in 16 and percutaneous abscess drainage in three. Nephrectomy was performed a mean (range) of 5.7 (0-31) days after hospital admission. Thirteen patients (20%) died from septic multi-organ failure after surgery. This group was almost 20 years older than those who survived (78.6 vs 61.8 years), had a higher comorbidity rate, had undergone endourological interventions more frequently (69% vs 52%), had a longer interval to nephrectomy (6.9 vs 5.4 days), higher C-reactive protein level (294.9 vs 136.0 mg/L) and lower platelet counts (229.5 vs 307.7 million/L) at diagnosis. CONCLUSION: Several factors were identified that influence the outcome after emergency nephrectomy for life-threatening urosepsis. Applied to the decision-making process, these risk factors could have a positive impact on establishing a timely indication for nephrectomy that might ultimately reduce the high mortality rate.
Authors:
Ingrid Berger; Sonja Wildhofen; Alexander Lee; Anton Ponholzer; Michael Rauchenwald; Othmar Zechner; Walter Stackl; Stephan Madersbacher
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2009-03-18
Journal Detail:
Title:  BJU international     Volume:  104     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-20     Completed Date:  2009-09-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  386-90     Citation Subset:  IM    
Affiliation:
Department of Urology and Andrology, Donauspital, Vienna, Austria.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
C-Reactive Protein / metabolism
Child
Emergencies
Epidemiologic Methods
Female
Humans
Kidney Diseases / complications,  mortality,  surgery*
Male
Middle Aged
Nephrectomy / methods*
Sepsis / etiology,  mortality,  surgery*
Treatment Outcome
Urinary Tract Infections / complications,  mortality,  surgery*
Young Adult
Chemical
Reg. No./Substance:
9007-41-4/C-Reactive Protein

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