[Clinical indications for echography in acute pyelonephritis in adult women]

Echography is a non-invasive procedure which detects abnormalities in kidney and/or urinary tract.

To determine whether the routine use of an echography in women with the diagnosis of acute pyelonephritis (APN) provides relevant findings to diagnosis and determines a change in therapy.

A total of 100 patients admitted to the hospital with the diagnosis of APN who had undergone an echography were studied. Seven clinical criteria were evaluated: persistent fever for longer than 72 hours after starting an appropriate antibiotic therapy, episodes of previous urinary tract infections, previous history of kidney stones, anatomic abnormalities in the urinary tract, colic pain, persistent hematuria, and pregnancy. On the basis of these criteria two groups were defined: a) indicated echography (IE), for patients fulfilling at least one the above criteria; b) non-indicated echography (NIE), for patients fulfilling none of the above criteria.

IE group was made up of 47 patients, with a normal echography in 18 (38%); the NIE group was made up of 53 women, with a normal echography in 51 of them (96%). The abnormal findings in echography led to a change in therapeutic behaviour in 11 patients in the IE group (23%) and in 2 patients in the NIE group (4%).

The routine use of abdominal echography in women with the diagnosis of APN is not indicated in absence of clinical data supporting the presence of a complicated APN.