Role of emergency ultrasound screening in the management of acute pyelonephritis in emergency department: A large observational study from a tertiary care center of South India

Mitra, Shubhanker; Acharya, Harshdeep; Dua, Jivansha; Mutyala, Surendra Kumar; Abhilash, Kundavaram Paul Prabhakar; Yadav, Bijesh; Kumar, NK Shyam

doi:10.4103/0972-4958.198461

Cited by 4 publications

(3 citation statements)

References 1 publication

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“…The proportion of clinically significant imaging found in our study remained low (14%) considering the total population, but it was similar to the proportion found by Van Nieuwkopp et al in their derivation cohort. Clinically significant imaging ranges from 7 to 46% across studies but with considerable disparities in populations, diagnosis definitions and the proportions and types of imaging performed [ 5 , 6 , 7 , 8 , 9 , 10 , 14 , 20 , 21 , 22 ]. The varying prevalence of urolithiasis across the world (e.g., 5–9% in Europe, 7–13% in North America and 10% in Japan) could influence local practices and explain some of the different proportions of pathological imaging [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Except for a history of urolithiasis, there were no statistically significant associations with other individual Van Nieuwkoop or EAU criteria. Several factors have been associated with the imaging of urological abnormalities in other studies, including impaired renal function (elevated creatinine/blood urea nitrogen or decreased glomerular filtration rate), diabetes mellitus, inflammatory biomarkers and age [ 5 , 6 , 9 , 20 , 21 , 27 ]. Those studies also identified pain requiring opioid administration, hypotension, a history of uropathy, urinary leucocytosis, a known urinary anomaly, known kidney disease, flank pain and a Pitt score > 1.…”

Section: Discussionmentioning

confidence: 99%

“…We computed sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV) and the area under the receiver operating characteristic curve (AUC) for each factor. Clinical factors were chosen based on previous studies [ 5 , 6 , 10 , 20 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

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Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection

Vanolli,

Jost,

Clerc

et al. 2024

Infectious Disease Reports

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Recent European Association of Urology (EAU) guidelines and a clinical prediction rule developed by Van Nieuwkoop et al. suggest simple criteria for performing radiological imaging for patients with a febrile urinary tract infection (UTI). We analysed the records of patients with a UTI from four hospitals in Switzerland. Of 107 UTI patients, 58% underwent imaging and 69% (95%CI: 59–77%) and 64% (95%CI: 54–73%) of them were adequately managed according to Van Nieuwkoop’s clinical rule and EAU guidelines, respectively. However, only 47% (95%CI: 33–61%) and 57% (95%CI: 44–69%) of the imaging performed would have been recommended according to their respective rules. Clinically significant imaging findings were associated with a history of urolithiasis (OR = 11.8; 95%CI: 3.0–46.5), gross haematuria (OR = 5.9; 95%CI: 1.6–22.1) and known urogenital anomalies (OR = 5.7; 95%CI: 1.8–18.2). Moreover, six of 16 (38%) patients with a clinically relevant abnormality displayed none of the criteria requiring imaging according to Van Nieuwkoop’s rule or EAU guidelines. Thus, adherence to imaging guidelines was suboptimal, especially when imaging was not recommended. However, additional factors associated with clinically significant findings suggest the need for a new, efficient clinical prediction rule.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection

Vanolli,

Jost,

Clerc

et al. 2024

Infectious Disease Reports

View full text Add to dashboard Cite

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Xanthogranulomatous Pyelonephritis: A Complicated Febrile Urinary Tract Infection Detected by Point-of-Care Ultrasound in the Emergency Department

Gibbons

Leonard

Magee

et al. 2018

The Journal of Emergency Medicine

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Acute Renal Infection in Adult, Part 1: An Overview of What the Radiologist Needs to Know

Hazarika

Venkataramanan

Das

et al. 2019

Journal of Gastrointestinal and Abdominal Radiology

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Acute renal infection or acute pyelonephritis (AP) denotes the process of inflammation of the renal parenchyma and its collecting system and the urothelium following infection. Uncomplicated AP commonly affects otherwise healthy, young women without structural or functional urinary tract abnormalities and without relevant comorbidities. More severe and complicated AP occurs in patients with a structurally or functionally abnormal genitourinary tract, or in persons with a predisposing medical condition like immune compromised state and diabetes. Complicated AP is characterized by a broader spectrum of clinical presentations, a wider variety of infecting organisms, and a greater risk of progression to a complication, such as intrarenal or perinephric abscess or emphysematous pyelonephritis and has the capacity to damage the organ and at times maybe life threatening. Role of imaging in renal infection is secondary, and in most situations, imaging is done to confirm the clinical diagnosis, map progression of disease in immune-compromised group of patients, or to evaluate for potential complications and therapeutic interventions. This article attempts to discuss the pathophysiology of AP from the standpoint of medical imaging and also brings out illustrative examples of various manifestations of AP and its complications. It provides imaging insight into various stages of inflammation, development of complication, and a roadmap for understanding AP through cross-sectional imaging.

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Role of emergency ultrasound screening in the management of acute pyelonephritis in emergency department: A large observational study from a tertiary care center of South India

Cited by 4 publications

References 1 publication

Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection

Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection

Xanthogranulomatous Pyelonephritis: A Complicated Febrile Urinary Tract Infection Detected by Point-of-Care Ultrasound in the Emergency Department

Acute Renal Infection in Adult, Part 1: An Overview of What the Radiologist Needs to Know

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