Ultrasonography and computed tomography in severe urinary tract infection

Area of Science:

• Nephrology
• Radiology
• Infectious Diseases

Background:

• Urinary tract infections (UTIs) are common, with upper UTIs potentially leading to severe complications.
• Accurate imaging is crucial for diagnosing and managing acute pyelonephritis and its complications.

Purpose of the Study:

• To evaluate the diagnostic utility of renal computed tomography (CT) and ultrasonography in hospitalized patients with suspected upper UTIs.
• To compare the sensitivity of CT and ultrasonography in detecting acute pyelonephritis, focal bacterial nephritis, and intrarenal abscesses.

Main Methods:

• Prospective study involving 35 hospitalized patients undergoing treatment for UTIs.
• Renal computed tomography (CT) and renal ultrasonography were performed on all patients.
• Imaging findings were correlated with clinical diagnoses.

Main Results:

• Renal CT demonstrated abnormalities in 18/28 patients with acute pyelonephritis and 3/4 with urosepsis.
• CT findings were consistent with pyelonephritis (17 patients) and intrarenal abscess/focal bacterial nephritis (4 patients).
• Renal sonography was abnormal in only 8 patients, detecting pyelonephritis (4 patients) and abscess/focal bacterial nephritis (4 patients).
• Flank tenderness was absent in 4 patients with CT-confirmed pyelonephritis, three of whom had diabetes mellitus.

Conclusions:

• Renal CT is a sensitive diagnostic test for acute upper urinary tract infections.
• Ultrasonography is effective for detecting focal bacterial nephritis and abscesses but is insensitive to uncomplicated upper UTIs.
• Painless pyelonephritis may occur more frequently in patients with diabetes mellitus.