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Imaging in Acute Pyelonephritis: Utilization, Findings, and Effect on Management
Cason Pierce1, Angela Keniston1, Richard K Albert1
1From Denver Health Medical Center, Denver, and the University of Colorado Anschutz School of Medicine, Aurora.
Southern Medical Journal
|February 2, 2019
Summary
Imaging is often performed early for acute pyelonephritis, with over half of positive findings leading to procedures. Ultrasound may be preferred over CT for early imaging due to common interventions for stone disease.
Area of Science:
- Nephrology
- Radiology
- Infectious Diseases
Background:
- Acute pyelonephritis is a common kidney infection requiring prompt diagnosis and management.
- Imaging plays a crucial role in evaluating pyelonephritis severity and guiding treatment.
- Current guidelines recommend specific timing and modalities for imaging in pyelonephritis.
Purpose of the Study:
- To assess the frequency and timing of imaging in acute pyelonephritis patients.
- To determine the impact of imaging findings on therapeutic interventions.
- To evaluate the utility of different imaging modalities in this patient population.
Main Methods:
- Retrospective chart review of 739 adult patients diagnosed with acute pyelonephritis.
- Analysis of imaging obtained within 24 hours of admission.
- Stratification of patients based on risk factors for complications.
- Assessment of positive imaging findings and subsequent invasive interventions.
Main Results:
- 63% of patients received imaging within 24 hours of admission.
- Positive imaging findings occurred in 25% of all patients, higher in those with risk factors (30%).
- 50% of patients with positive early imaging underwent invasive procedures, primarily for obstruction (51/59).
Conclusions:
- Imaging is frequently performed earlier than recommended in acute pyelonephritis.
- Ultrasound may be a more appropriate initial imaging modality than contrasted CT, given the prevalence of stone disease interventions.
- Current guidelines for imaging in acute pyelonephritis may require revision.
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