SAFETY AND EFFICACY OF DOUBLE J STENTING IN MANAGEMENT OF GRADE 2 AND 3A EMPHYSEMATOUS PYELONEPHRITIS

Abstract

Background:
Emphysematous pyelonephritis (EPN) is a rare, serious, and life-threatening disease that causes necrosis of renal tissue and formation of gas inside the kidney and its surrounding structures. This condition mainly occurs in diabetics and has been linked with high morbidity and mortality rates. EPN was previously treated using conservative antibiotic therapy up to nephrectomy. Currently, there is an increasing trend towards minimal invasive treatment like Double J (DJ) stenting.

Objective:
To determine the safety and efficacy of Double J stenting in the management of Grade 2 and Grade 3a Emphysematous Pyelonephritis and to assess the frequency of adverse outcomes associated with the procedure.

Methodology:
A descriptive case series study was carried out at the Department of Urology, Shaikh Zayed Hospital, Lahore, from February 04, 2026, to June 04, 2026. A total of 93 patients aged 18 to 70 years suffering from radiologically proven Grade 2 and 3a EPN were selected through a non-probability consecutive sampling technique. All patients had DJ stenting after taking informed consent. Clinical, laboratory, microbiology, and radiology findings of the patients were documented using a structured proforma. Management of patients included the use of antibiotics, glycemic control, and support, as well as hemodialysis in case of necessity. Efficacy was determined on the basis of clinical improvement, laboratory findings, radiology clearance, and further interventions. Data were analyzed using SPSS version 26.

Results:
The mean age of the patients was 51.8 ± 12.4 years, with females comprising 59.1% of the study population. Diabetes mellitus was present in 77.4% of patients, while 19.4% had chronic kidney disease. Grade 2 EPN was observed in 58.1% and Grade 3a EPN in 41.9% of patients. Radiological clearance was achieved in 76.3% of patients following DJ stenting. Hemodialysis was required in 25.8%, while nephrectomy was required in 11.8% of cases. The mortality rate was 11.8%. Univariate analysis showed significant associations of age, diabetes mellitus, hypertension, CKD, Grade 3a EPN, elevated TLC, and hemodialysis requirement with early complications. Multivariate logistic regression identified Grade 3a EPN (OR=3.8, p=0.009), CKD (OR=3.1, p=0.015), and hemodialysis requirement (OR=4.6, p=0.005) as independent predictors of complications.

Conclusion:
Double J stenting is a safe and effective minimally invasive management option for Grade 2 and Grade 3a Emphysematous Pyelonephritis, with a high radiological clearance rate and low nephrectomy requirement. However, patients with advanced disease, renal dysfunction, and associated comorbidities remain at higher risk of complications and require close monitoring.