Acute pyelonephritis in adults. Should we adopt the pediatric guidelines?

There are no guidelines, what recommend pro or against cystography for identification of VUR for adults who suffer from first episode of pyelonephritis. The aim of this study was to look at incidence of VUR in adults with first episode of pyelonephritis, and to highlight recommendations for possible reflux investigation in these patients.

We have performed retrospective review of all patients who admitted at our department over the last decade with the working diagnosis of acute pyelonephritis. Following discharge from the department, individuals with no pre-existing urological history were advised to undergo a VCUG or CEVUS.

We have identified 76 patients (62 females and 14 males) with an average age of 31.73 years who were hospitalized in our departments between 2006 and 2022. Forty-eight (63%) presented with right pyelonephritis, 26(34%) with left, and 2(3%) had bilateral disease. Of those, 23(30%) patients returned for clinical follow-up after completion of VCUG/CEVUS. Reflux was demonstrated in 14(60%) patients comprising 18 renal refluxing units (RRU). Six had grade IV reflux, 4 grade III, 4 grade II, and 4 grade I respectively. DMSA demonstrated 27.2 ± 11.9% relative function of the reflux kidney. Of those VUR patients, 9(64%) underwent endoscopic correction, 1(7%) refused surgery, and 4(29%) are under clinical follow-up.

Our data demonstrate high incidence of VUR in adult patients with acute pyelonephritis patients, therefore VUR investigation at least should be considered in adult patients even after first episode of pyelonephritis, especially in cases where there is evidence of nephronia, abscess, kidney scars, atrophic kidney, or hydronephrosis.