A prospective, two arm, observational study to analyze the factors predicting the role of double J stenting technique in management of acute pyelonephritis

Vikash Kumar; Samit Doshi; Harshad M. Kavad; Ajaykumar Gajengi; Siva Prasad Gourabathini

doi:10.18203/2320-6012.ijrms20263509

Authors

Vikash Kumar Department of Urology, Bhaktivedanta Hospital and Research Institute, Mumbai, Maharashtra, India
Samit Doshi Department of Urology, Bhaktivedanta Hospital and Research Institute, Mumbai, Maharashtra, India
Harshad M. Kavad Department of Urology, Bhaktivedanta Hospital and Research Institute, Mumbai, Maharashtra, India
Ajaykumar Gajengi Department of Urology, Bhaktivedanta Hospital and Research Institute, Mumbai, Maharashtra, India
Siva Prasad Gourabathini Department of Urology, Bhaktivedanta Hospital and Research Institute, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263509

Keywords:

Acute pyelonephritis, DJ stenting, Serum creatinine, Fever

Abstract

Background: Acute pyelonephritis is a severe urinary tract infection with variable presentation, ranging from mild illness to septic shock. While most patients respond to antimicrobial therapy, some require early urological intervention such as Double J (DJ) stenting. Identifying predictors for intervention is crucial. Aim was to assess factors determining the need for DJ stenting and analyse the clinical profile and predisposing factors in patients with acute pyelonephritis.

Methods: This prospective study was conducted over one year at a tertiary care centre and included 60 patients diagnosed with acute pyelonephritis. Patients were divided into Group A (conservative management) and Group B (DJ stenting). Clinical features, laboratory parameters, imaging findings, and treatment outcomes were analysed. Statistical analysis used chi-square and unpaired t tests, with p<0.05 considered significant.

Results: Most patients were aged 51-70 years, with female predominance (61.7%). Age, gender, diabetes, and comorbidities did not differ significantly between groups. Significant predictors of DJ stenting included chills (p=0.004), flank pain (p=0.035), lower urinary tract symptoms (LUTS) (p=0.009), nausea/vomiting (p=0.045), high-grade fever >100.4°F (p=0.001), persistent tachycardia (p=0.001), tender palpable kidney (p=0.001), pyuria (p=0.0001), thrombocytopenia (p=0.001), hyponatremia (p=0.004), and HbA1c >9% (p=0.001). Elevated creatinine, total leukocyte count, and positive blood and urine cultures were also significantly associated with stenting (p=0.001).

Conclusions: Multiple adverse clinical and laboratory parameters predict failure of conservative management. Patients with three or more poor prognostic factors may benefit from early DJ stenting, potentially improving outcomes and preventing complications.

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