Computerized Tomography in Acute Pyelonephritis: The Clinical Correlations

Tsugaya, Masayuki; Hirao, Noriaki; Sakagami, Hiroshi; Iwase, Yutaka; Watase, Hideki; Ohtaguro, Kazuo; Washida, Hiroto

doi:10.1016/s0022-5347(17)39536-8

Cited by 19 publications

(8 citation statements)

References 8 publications

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“…The imaging modality used most often was renal ultrasound, mainly because it is relatively cheap and non‐invasive. Use of non‐contrast spiral CT has become more popular in recent years because it is now more readily available and is much more sensitive in detecting underlying renal abnormalities, particularly renal calculi, compared with ultrasound 7–9 . Some debate remains though, as to whether CT is as reliable as ultrasound for detecting urinary tract obstruction.…”

Section: Discussionmentioning

confidence: 99%

Renal imaging in pyelonephritis

Shen

Brown

2004

Nephrology

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Although our study did not test whether immediate imaging is more advantageous than delaying imaging for those who fail to respond to treatment, our findings suggest that early imaging is a cost-effective part of management. On the basis of these data, we recommend renal imaging for all patients requiring hospital admission for pyelonephritis, and suggest that initial empirical therapy should include an intravenous dose of cephalosporin but not ampicillin.

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Section: Discussionmentioning

confidence: 99%

Renal imaging in pyelonephritis

Shen

Brown

2004

Nephrology

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“…However, the imaging abnormalities are reported to heal over 1-5 months, and the delay in healing correlates best with persistent pyuria. The persistent urinary leukocytes imply residual inflammation that can usually be detected with CT (24,25).…”

Section: Imaging Featuresmentioning

confidence: 99%

Pyelonephritis: Radiologic-Pathologic Review

Craig¹,

Wagner²,

Travis³

2008

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Urinary tract infections are the most common urologic disease in the United States and annually account for over 7 million office and 1 million emergency department visits. In adults, diagnosis of urinary tract infection is typically based on characteristic clinical features and abnormal laboratory values. Imaging is usually reserved for patients who do not respond to therapy and for those whose clinical presentation is either atypical or potentially life threatening. Urinary tract infection typically originates in the urinary bladder; when it migrates to the kidney or is seeded there hematogenously, a tubulointerstitial inflammatory reaction ensues, involving the renal pelvis and parenchyma. The condition is characterized as pyelonephritis. Complicated and uncomplicated pyelonephritis, xanthogranulomatous pyelonephritis, and tuberculosis are all urinary tract infections for which imaging evaluation adds diagnostic information important for patient care. Computed tomography (CT), when performed before, immediately after, and at delayed intervals from contrast material injection, is the preferred modality for evaluating acute bacterial pyelonephritis. CT is also preferred over conventional radiography and ultrasonography (US) for assessing emphysematous pyelonephritis. Xanthogranulomatous pyelonephritis is a chronic granulomatous process, induced by recurrent bacterial urinary tract infection. Although US is useful in the diagnosis of this condition, CT is the main imaging tool, as it provides highly specific findings and accurate assessment of the extrarenal extent of disease, which is essential for surgical planning. The increasing prevalence of tuberculosis and continued emergence of antibiotic-resistant strains have significance for genitourinary radiologists, as the urinary tract is the most common extrapulmonary site of tuberculosis. Familiarity with the renal manifestations of the disease--pelvoinfundibular strictures, papillary necrosis, cortical low-attenuation masses, scarring, and calcification--will help in the diagnosis, even in the absence of documented pulmonary disease.

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“…17 Resolution of imaging findings typically lags behind clinical improvement; abnormalities may be seen on CT for up to 5 months following the initial infection. 18 …”

Section: Infection Pyelonephritismentioning

confidence: 99%