Objectives: To analyze the risk factors of uroseptic shock induced by calculous acute pyelonephritis (APN). Methods: This study included 69 patients (41 were women and 28 were men) who were admitted to our hospital for APN treatment associated with urolithiasis during the period from January 2005 to December 2012. We reviewed the electronic medical records of these patients to analyze risk factors contributing to the development of uroseptic shock from APN in patients with urolithiasis. Results: Urinary drainage with ureteral stent or nephrostomy was carried out in 62 cases. Septic shock requiring vasopressor infusion against circulatory collapse was observed in 25 patients, these patients showed significantly lower serum albumin levels and higher C-reactive protein (CRP) compared to patients who did not exhibit septic shock. Multivariate analysis revealed that serum albumin level and CRP were the significant risk factors for the development of uroseptic shock from calculous APN. Conclusions: Serum albumin level was the significant risk factor for the development of uroseptic shock from calculous APN. Emergency drainage to decompress the obstructed urinary tract is mandatory as an initial urological intervention for the patients with lower serum albumin level.

1.
Charlson M, Szatrowski TP, Peterson J, Gold J: Validation of a combined comorbidity index. J Clin Epidemiol 1994; 47: 1245–1251.
2.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644–1655.
3.
Ramakrishnan K, Scheid DC: Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician 2005; 71: 933–942.
4.
Bass PF 3rd, Jarvis JA, Mitchell CK: Urinary tract infections. Prim Care 2003; 30: 41–61.
5.
Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG: Acute pyelonephritis: clinical characteristics and the role of the surgical treatment. J Korean Med Sci 2009; 24: 296–301.
6.
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: Efficacy of treatment with carbapenems and third-generation cephalosporins for patients with febrile complicated pyelonephritis. J Infect Chemother 2009; 15: 390–395.
7.
Ramsey S, Robertson A, Ablett MJ, Meddings RN, Hollins GW, Little B: Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi. J Endourol 2010; 24: 185–189.
8.
Yoshimura K, Utsunomiya N, Ichioka K, Ueda N, Matsui Y, Terai A: Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol 2005; 173: 458–462.
9.
Lee JH, Lee YM, Cho JH: Risk factors of septic shock in bacteremic acute pyelonephritis patients admitted to an ER. J Infect Chemother 2011; 18: 130–133.
10.
Hsu CY, Fang HC, Chou KJ, Chen CL, Lee PT, Chung HM: The clinical impact of bacteremia in complicated acute pyelonephritis. Am J Med Sci 2006; 332: 175–180.
11.
Koga S, Arakaki Y, Matsuoka M, Ohyama C: Calculous pyelonephritis. Int Urol Nephrol 1992; 24: 109–112.
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