Renal Salvage in Pyonephrosis: A Retrospective Observational Study at a Tertiary Care Center in North India.

Introduction  Pyonephrosis is a urological emergency associated with a high risk of sepsis and irreversible renal damage. Early diagnosis and timely drainage are critical for renal salvage and for reducing morbidity and mortality. Data from tertiary care centers in our region are limited. This study evaluates the clinical profile, management, and outcomes of pyonephrosis over a five-year period at a tertiary referral center. Materials and methods  This retrospective study included 90 adult patients diagnosed with pyonephrosis at the Department of Urology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, between August 2020 and July 2025. The objectives of the study were to evaluate renal salvage outcomes in pyonephrosis and to identify clinical, radiological, and etiological factors influencing salvageability. Demographic, clinical, laboratory, imaging, and treatment details were analyzed. Statistical analysis was performed using IBM SPSS Statistics version 25. Results  The mean age was 45.1 years, with male predominance (57%); 83% of patients were from rural areas. Urolithiasis was the most common etiology (46.7%), followed by pelvi-ureteric junction (PUJ) obstruction (16.7%) and malignancy (13.3%). Left-sided involvement was seen in 47%, right-sided in 43%, and bilateral disease in 10%. Initial urinary drainage was achieved by percutaneous nephrostomy (PCN) in 50%, Double-J (DJ) stenting in 16.6%, and combined DJ stenting with PCN in 20%. Definitive treatment included nephrectomy in 46.7%, percutaneous nephrolithotomy (PCNL) in 24.1%, and pyeloplasty in 10.3%. Renal salvage was achieved in 53.3% of patients. Factors significantly associated with non-salvage included older age (p = 0.046), acute kidney injury (p < 0.0001), sepsis at presentation (p < 0.0001), parenchymal thickness < 5 mm (p < 0.0001), prolonged symptom duration (p < 0.0001), and severe hydronephrosis (p < 0.0001). Conclusions  Urolithiasis remains the leading cause of pyonephrosis. Prompt imaging and early urinary decompression are essential for renal salvage and improved clinical outcomes.