The Usefulness of the Interpretation of Initial Plain CT Scan in Hospitalized Patients with Acute Pyelonephritis without Obstructive Uropathy
International Journal of Infectious Diseases and Therapy
Volume 4, Issue 1, March 2019, Pages: 7-12
Received: Feb. 8, 2019;
Accepted: Apr. 9, 2019;
Published: May 15, 2019
Views 303 Downloads 21
Takehiro Sejima, Department of Urology, Matsue City Hospital, Matsue, Japan
Shuichi Morizane, Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
Katsuya Hikita, Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
Masashi Honda, Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
Atsushi Takenaka, Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
Follow on us
To investigate the association between plain computed tomography (CT) findings and clinical characteristics and to characterize the potential factors affecting the disease outcome in hospitalized patients with acute pyelonephritis (APN) without obstructive uropathy, we reviewed our clinical database retrospectively. Five plain CT scan abnormal kidney findings of perirenal fat stranding, thickening of perirenal fasciae, kidney enlargement, dilation of renal pelvis, and abnormal density of renal parenchyma were elucidated in 70 patients with APN without obstructive uropathy who were hospitalized. The association between CT scan findings and clinical characteristics were analyzed. Logistic regression analysis was performed to characterize the potential factors that affect the period until the patient was afebrile using various clinical factors and five defined CT scan findings. Perirenal fat stranding and dilation of renal pelvis were significantly frequent in females and patients with diabetes mellitus. Serum inflammation markers were significantly deteriorated in patients with perirenal fat stranding, thickening of perirenal fasciae and kidney enlargement compared to patients with normal findings. An age-adjusted Charlson comorbidity index ≥ 5 and low serum albumin values were significantly associated with a prolonged febrile period. In conclusion, although abnormal plain CT scan findings at diagnosis are associated with some clinical characteristics, the patient’s intrinsic factors are more useful for predicting the disease outcome in hospitalized patients with APN without obstructive uropathy.
Computed Tomography, Hospitalized Patient, Kidney, Pyelonephritis
To cite this article
The Usefulness of the Interpretation of Initial Plain CT Scan in Hospitalized Patients with Acute Pyelonephritis without Obstructive Uropathy, International Journal of Infectious Diseases and Therapy.
Vol. 4, No. 1,
2019, pp. 7-12.
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Stunell H, Buckley O, Feeney J, et al. Imaging of acute pyelonephritis in the adult. Eur Radiol. 2007; 17: 1820-1828.
Lim SK, Ng FC. Acute pyelonephritis and renal abscesses in adults—correlating clinical parameters with radiological (computer tomography) severity. Ann Acad Med Singapore. 2011; 40: 407-413.
Expert Panel on Urologic Imaging (2012) ACR Appropriateness Criteria Acute Pyelonephritis. Available at: https://acsearch.acr.org/docs/69489/Narrative/
Oh SJ, Je BK, Lee SH, et al. Comparison of computed tomography findings between bacteremic and non-bacteremic acute pyelonephritis due to Escherichia coli. World J Radiol. 2016; 8: 403-409.
Yuh BI, Cohan RH, Francis IR, et al. Comparison of nephrographic with excretory phase helical computed tomography for detecting and characterizing renal masses. Can Assoc Radiol J. 2000; 51: 170-176.
Taniguchi LS, Torres US, Souza SM, et al. Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis? Acta Radiol. 2017; 58: 634-640.
Kim JS, Lee S, Lee KW, et al. Relationship between uncommon computed tomography findings and clinical aspects in patients with acute pyelonephritis. Korean J Urol. 2014; 55: 482-486.
Ramakrishnan K, Scheid DC. Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician. 2005; 71: 933-942.
Tseng CC, Wu JJ, Wang MC, et al. Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Am J Kidney Dis. 2005; 46: 432-439.
Scholes D, Hooton TM, Roberts PL, et al. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med. 2005; 142: 20-27.
Kim SH, Kim YW, Lee HJ. Serious acute pyelonephritis: a predictive score for evaluation of deterioration of treatment based on clinical and radiologic findings using CT. Acta Radiol. 2012; 53: 233-238.
Pertel PE, Haverstock D. Risk factors for a poor outcome after therapy for acute pyelonephritis. BJU Int. 2006; 98: 141-147.
Efstathiou SP, Pefanis AV, Tsioulos DI, et al. Acute pyelonephritis in adults: prediction of mortality and failure of treatment. Arch Intern Med. 2003; 163: 1206-1212.