Relationship Between Uncommon Computed Tomography Findings and Clinical Aspects in Patients With Acute Pyelonephritis

Abstract

PurposeComputed tomography (CT) has become popular in the diagnosis of acute pyelonephritis (APN) and its related complications in adults. The aim of this study was to investigate the relationship between uncommon CT findings and clinical and laboratory data in patients with APN.Materials and MethodsFrom July 2009 to July 2012, CT findings and clinical data were collected from 125 female patients with APN. The six uncommon CT findings (excluding a wedge-shaped area of hypoperfusion in the renal parenchyma) studied were perirenal fat infiltration, ureteral wall edema, renal abscess formation, pelvic ascites, periportal edema, and renal scarring. The clinical parameters analyzed were the age and body mass index of the patients as well as the degree and duration of fever. Laboratory parameters related to inflammation and infection included white blood cell count, C-reactive protein (CRP) level, erythrocyte sedimentation rate, pyuria, and bacteriuria.ResultsThe most common CT finding was perirenal fat infiltration (69 cases, 55%). A longer duration of fever, higher CRP level, and grade of pyuria were related with perirenal fat infiltration (p=0.010, p=0.003, and p=0.049, respectively). The CRP level was significantly higher in patients with renal abscess and ureteral wall edema (p=0.005 and p=0.015, respectively).ConclusionsThe uncommon CT findings that were related to aggravated clinical and laboratory parameters of APN patients were perirenal fat infiltration, ureteral wall edema, and renal abscess formation. The inflammatory reaction and tissue destruction may be more aggressive in patients with these CT findings.

The Usefulness of the Interpretation of Initial Plain CT Scan in Hospitalized Patients with Acute Pyelonephritis without Obstructive Uropathy

“…Renal parenchymal inflammation causes perirenal tissue changes that are recognized as perirenal fat stranding and thickening of perirenal fasciae. Kim et al investigated the relationship between "uncommon CT findings" and clinical aspects in APN; however, the most common CT finding was perirenal fat infiltration (55% of cases) [7]. Our results and previous studies suggest that the perirenal tissue change detected by CT scanning is a common pathogenesis of APN.…”

CT Grading in Upper Urinary Tract Calculi with Kidney Infection

“…Kim et al showed that CT image grading could be used to predict the severity and course of disease [32]. The higher the CT grades were, the worse the clinical symptoms and the prognosis were [32]. By CT grading, we evaluated the degree of kidney infection and our results may better guide the treatment.…”

“…Therefore, results of the study showed that the higher the CT grade was, the greater the risk of SIRS in patients with upper urinary tract calculi were, which provides clinical guidance for early clinical diagnosis and treatment of SIRS. Kim et al showed that CT image grading could be used to predict the severity and course of disease [32]. The higher the CT grades were, the worse the clinical symptoms and the prognosis were [32].…”

Clinical Usefulness of Unenhanced Computed Tomography in Patients with Acute Pyelonephritis

“… 22 Perirenal fat infiltration is observed when the inflammation of the renal parenchyma spreads beyond the renal capsule into the perirenal fat. 7 The stranding likely represents fluid that collects within the bridging septa of the perinephric fat as a result of increased lymphatic pressure. Fluid collections may become asymmetric in the presence of unilateral obstruction or pyelonephritis.…”

“… 1 2 4 5 6 ECT shows both the intrarenal and extrarenal areas as precise images and provides comprehensive anatomical information. 7 It also enables the detection of complications such as renal or perinephric abscess. 8 However, the administration of iodinated contrast agents used during ECT increases the risk of contrast-induced acute kidney injury (CIAKI).…”