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Acute bacterial nephritis: a clinicoradiologic correlation based on computed tomography
J J Huang1, J M Sung, K W Chen
1Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China.
The American Journal of Medicine
|September 1, 1992
Summary
Computed tomography (CT) findings in acute bacterial nephritis (ABN) correlate with clinical severity, classifying ABN into three groups. This classification aids in understanding pathophysiology and guiding patient management for better outcomes.
Area of Science:
- Radiology
- Infectious Diseases
- Nephrology
Background:
- Acute bacterial nephritis (ABN) is a localized renal infection with variable clinical presentations.
- Previous studies lacked consistent correlation between clinical course and radiologic findings in ABN.
- Computed tomography (CT) can detect alterations in renal tissue density indicative of ABN.
Purpose of the Study:
- To correlate the severity of clinical manifestations with CT findings in ABN.
- To elucidate the natural history and pathophysiology of ABN.
- To provide insights into the clinical management of ABN.
Main Methods:
- Retrospective evaluation of 30 ABN cases from July 1988 to June 1991.
- Classification of 28 cases into three groups based on postcontrast-enhanced CT findings: wedge-shaped lesions (Group I), focal mass-like lesions (Group II), and diffuse mass-like lesions (Group III).
- Comparison of clinical features and outcomes across the three groups; assessment of ultrasonography (US) and urography utility.
Main Results:
- Excellent correlation found between clinical parameters (fever, leukocyte count, pain, pyuria, shock, ketoacidosis, renal failure) and CT patterns.
- Group I (wedge-shaped lesions) showed prompt response to antibiotics, similar to uncomplicated acute pyelonephritis (APN).
- Group II (mass-like lesions) had a protracted course, with one case progressing to renal abscess; Group III (diffuse mass-like lesions) had a 33% mortality rate despite antibiotics.
- US was sensitive for Group II lesions (62%) and detected renal enlargement in Group III (89%).
Conclusions:
- Renal bacterial infection progresses from uncomplicated APN to ABN, with CT showing a spectrum from wedge-shaped to mass-like lesions, potentially leading to abscess formation.
- Classification of ABN into three CT-defined subgroups demonstrates good correlation with clinical severity.
- Findings offer valuable insights into ABN pathophysiology and clinical management strategies.