Acute pyelonephritis: can we agree on terminology?

Talner, Lee B.; Davidson, A J; Lebowitz, Robert L.; Palma, L. Dalla; Goldman, S M

doi:10.1148/radiology.192.2.8029384

Cited by 110 publications

(58 citation statements)

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“…Both tests are considered gold standards for this purpose. 5 A UTI can be localized in neurogenic bladder disease using the wash-out test 7 in females and in combination with ®ve glass-specimen tests in males. 8 The techniques were described by Wyndaele et al 7,8 and have been used in our department since 1979.…”

Section: Methodsmentioning

confidence: 99%

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Diagnosis and localization of a complicated urinary tract infection in neurogenic bladder disease by tubular proteinuria and serum prostate specific antigen

Everaert¹,

Oostra²,

Delanghe³

et al. 1998

Spinal Cord

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Introduction: Urinary tract infection is the most frequent complication occurring in patients with spinal cord injuries and can cause renal failure and male infertility. We used the urinary a-1-microglobulin (a1Mg) as a marker for pyelonephritis and the serum prostate speci®c antigen (PSA) as a marker for prostatitis with reference to the currently available methods. The aim of our study is (1) to di erentiate between upper (pyelonephritis) and lower urinary tract infection (cystitis, prostatitis) in neurogenic bladder disease, (2) to determine if high (438.58C) fever in a neurogenic bladder disease patient was due to urological (prostatitis, pyelonephritis) causes or not. Patients and methods:We evaluated 147 patients of whom 27 had acute pyelonephritis, 16 had prostatitis with fever, 13 had chronic pyelonephritis, 68 had cystitis; 23 were control patients of whom nine had fever (438.58C) and 14 did not. The diagnoses and localizations were made on the basis of clinical evidence, with a CT scan, urography, bladder wash-out tests, and ®ve glass-specimen tests. The urinary a1Mg was determined using latex enhanced immunonephelometry and the serum PSA was measured using RIA. Results: For the urinary a1Mg, the sensitivity is 96% and the speci®city 93% for the diagnosis of acute pyelonephritis. The serum PSA has a sensitivity of 69% and speci®city of 96% in the diagnosis of prostatitis. The urinary a1Mg has a sensitivity of 96% and a speci®city of 56% and the serum PSA has a sensitivity of 68% and a speci®city of 100% in the di erential diagnosis of prostatitis and pyelonephritis. The best discriminative parameter between pyelonephritis and prostatitis was the urinary a1Mg/serum PSA ratio with a sensitivity of 92% and speci®city of 88%. Conclusion: Upper-tract infection with fever can be diagnosed in neurogenic bladder disease by determining the urinary a1Mg. In male patients, the serum PSA should be determined to distinguish upper-tract infection from prostatitis. High fever does not signi®cantly in¯uence our parameters so that we can di erentiate whether or not high fever is due to urological causes.

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Section: Methodsmentioning

confidence: 99%

“…CT scan and isotopic scans are considered the gold standards. 4,5 The bladder wash-out test can di erentiate between high and low UTI but it has never been accepted as the gold standard. This test can be false positive in prostatitis, 7 which itself is di cult to diagnose.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and localization of a complicated urinary tract infection in neurogenic bladder disease by tubular proteinuria and serum prostate specific antigen

Everaert¹,

Oostra²,

Delanghe³

et al. 1998

Spinal Cord

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“…A striated pattern of linear alternating increased and decreased attenuation ("striated nephrogram") on enhanced scans is classic [6]. This differential enhancement is contributed by various factors, namely, tubular obstruction by inflammatory debris, interstitial edema, and vasospasm which tend to decrease the flow of contrast through tubules [7,8].…”

Section: Acute Pyelonephritismentioning

confidence: 99%

“…Struvite stones develop more frequently in a patient with urinary stasis or recurrent urinary tract infections. Struvite stones with superimposed pyelonephritis are caused by bacteria entering the renal tubules and inciting an inflammatory response which involves the tubules and renal interstitium [7]. CT is useful in assessing intra-and extrarenal inflammation such as gas, calculus, and hemorrhage [4].…”

Section: Struvite Stone and Their Complicationsmentioning

confidence: 99%

“…CT is useful in assessing intra-and extrarenal inflammation such as gas, calculus, and hemorrhage [4]. CT shows the inciting staghorn calculus with superimposed pyelonephritis with wedgeshaped areas of decreased enhancement corresponding to the striated nephrogram and perinephric stranding [7,8]. Another complication is pyonephrosis, which is a dilated, obstructed, and infected collecting system.…”

Section: Struvite Stone and Their Complicationsmentioning

confidence: 99%

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