Evaluation of risk factors for emphysematous pyelonephritis among patients with type 2 diabetes mellitus

Abstract

Background: Emphysematous pyelonephritis is an acute and severe form of necrotising infection of kidneys and perinephric tissues. Diabetes mellitus, kidney stones and immune suppression states are recognised risk factors for emphysematous pyelonephritis. This study aimed to identify the risk factors contributing to emphysematous pyelonephritis among type 2 diabetic subjects.

Methods: This case-control study was done in the Department of Nephrology, BIRDEM General Hospital, Dhaka, Bangladesh from 2023 to 2025. Adult type 2 diabetic patients with computed tomography (CT) scan confirmed emphysematous pyelonephritis were cases and age and sex matched type 2 diabetic patients having acute pyelonephritis were controls. Duration of diabetes, status of glycaemic control (HbA1c), hypertension, pre-existing chronic kidney disease, presence of renal and/or ureteric stones, vesico-ureteric reflux and history of prior urinary tract infection were evaluated as risk factors for emphysematous pyelonephritis.

Results: Total patients were 42 including 21 cases and 21 controls. Univariate analysis revealed that high HbA1c [odds ratio (OR) 15.43, 95% confidence interval (CI) 2.81 – 84.72, p 0.0016], duration of diabetes (OR 2.23, 95% CI 0.36 – 13.78, p 0.38), presence of hypertension (OR 1.78, 95% CI 0.52 – 6.10, p 0.35), chronic kidney disease (OR 3.8, 95% CI 0.66 – 21.59, p 0.13) and renal/ureteric stone (OR 1.87, 95% CI 0.38 – 9.12, p 0.43) were risk factors for emphysematous pyelonephritis.

Conclusion: High HbA1c appeared as significant risk factor for emphysematous pyelonephritis among patients with type 2 diabetes mellitus.

BIRDEM Med J 2026; 16(2): 65-69