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The intravenous pyelogram in acute pyelonephritis.
K T Kanel1, F J Kroboth, F N Schwentker
1Department of Medicine, University of Pittsburgh School of Medicine, PA 15261.
Archives of Internal Medicine
|October 1, 1988
Summary
Uroradiography in acute pyelonephritis rarely changes management in healthy patients. Persistent fever after 72 hours of antibiotics significantly increases the diagnostic yield of genitourinary abnormalities.
Area of Science:
- Nephrology
- Urology
- Infectious Diseases
Background:
- Acute pyelonephritis often necessitates hospitalization and imaging studies.
- The utility of routine uroradiography in managing acute pyelonephritis is debated due to low diagnostic yield.
Purpose of the Study:
- To identify clinical predictors that enhance the specificity of intravenous pyelography in acute pyelonephritis.
- To determine the impact of uroradiography on patient management in this cohort.
Main Methods:
- Retrospective cohort study of 67 hospitalized patients with acute pyelonephritis.
- Analysis of clinical data, fever curves, comorbidities, and pathogen sensitivities.
- Evaluation of the impact of imaging findings on clinical management decisions.
Main Results:
- Only 8% of patients had genitourinary abnormalities influencing management; over 90% of studies did not alter care.
- Persistent fever (≥72 hours of antibiotics) increased the diagnostic yield of significant abnormalities from 8% to 36%.
- Diabetes and non-ampicillin-sensitive E. coli infections showed trends toward increased abnormalities, but lacked statistical significance.
Conclusions:
- Routine uroradiography in acute pyelonephritis has limited utility for management in most otherwise healthy patients.
- Fever persistence beyond 72 hours of appropriate antibiotic therapy is a key indicator for considering uroradiography.
- Further investigation is warranted for specific patient subgroups like diabetics or those with resistant pathogens.