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Acute Pyelonephritis
Alessandro Furlan, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Acute infection of renal parenchyma

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Lee YJ et al: Unilateral and bilateral acute pyelonephritis: differences in clinical presentation, progress and outcome. Postgrad Med J. 90(1060):80-5, 2014
                                              2. Vivier PH et al: MRI and suspected acute pyelonephritis in children: comparison of diffusion-weighted imaging with gadolinium-enhanced T1-weighted imaging. Eur Radiol. 24(1):19-25, 2014
                                              3. De Pascale A et al: Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis. Eur Radiol. 23(11):3077-86, 2013
                                              4. Faletti R et al: Diffusion-weighted imaging and apparent diffusion coefficient values versus contrast-enhanced MR imaging in the identification and characterisation of acute pyelonephritis. Eur Radiol. 23(12):3501-8, 2013
                                              5. Ghasemi K et al: Correlation of 99mTc-DMSA scan with radiological and laboratory examinations in childhood acute pyelonephritis: a time-series study. Int Urol Nephrol. 45(4):925-32, 2013
                                              6. Abraham G et al: Diagnosis of acute pyelonephritis with recent trends in management. Nephrol Dial Transplant. 27(9):3391-4, 2012
                                              7. Rollino C et al: Acute pyelonephritis in adults: a case series of 223 patients. Nephrol Dial Transplant. 27(9):3488-93, 2012
                                              8. Gupta K et al: International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 52(5):e103-20, 2011
                                              9. Martina MC et al: Dynamic magnetic resonance imaging in acute pyelonephritis. Radiol Med. 115(2):287-300, 2010
                                              10. Yoo JM et al: Diagnosing Acute Pyelonephritis with CT, Tc-DMSA SPECT, and Doppler Ultrasound: A Comparative Study. Korean J Urol. 51(4):260-5, 2010
                                              11. Craig WD et al: Pyelonephritis: radiologic-pathologic review. Radiographics. 28(1):255-77; quiz 327-8, 2008
                                              12. Mitterberger M et al: Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast-enhanced ultrasonography. BJU Int. 101(3):341-4, 2008
                                              13. Demertzis J et al: State of the art: imaging of renal infections. Emerg Radiol. 14(1):13-22, 2007
                                              14. Stunell H et al: Imaging of acute pyelonephritis in the adult. Eur Radiol. 17(7):1820-8, 2007
                                              15. Pertel PE et al: Risk factors for a poor outcome after therapy for acute pyelonephritis. BJU Int. 98(1):141-7, 2006
                                              16. Piccoli GB et al: Development of kidney scars after acute uncomplicated pyelonephritis: relationship with clinical, laboratory and imaging data at diagnosis. World J Urol. 24(1):66-73, 2006
                                              17. Zissin R et al: Extrarenal manifestations of severe acute pyelonephritis: CT findings in 21 cases. Emerg Radiol. 13(2):73-7, 2006
                                              18. Larcombe J: Urinary tract infection in children. Clin Evid. (14):429-40, 2005
                                              19. Ramakrishnan K et al: Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician. 71(5):933-42, 2005
                                              20. Sheffield JS et al: Urinary tract infection in women. Obstet Gynecol. 106(5 Pt 1):1085-92, 2005
                                              21. Wang YT et al: Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol. 173(1):190-4; discussion 194, 2005
                                              22. Fanos V et al: Antibiotics or surgery for vesicoureteric reflux in children. Lancet. 364(9446):1720-2, 2004
                                              23. Foxman B et al: Acute pyelonephritis in US hospitals in 1997: hospitalization and in-hospital mortality. Ann Epidemiol. 13(2):144-50, 2003
                                              24. Hoberman A et al: Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 348(3):195-202, 2003
                                              25. Lin KY et al: Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection. Pediatr Nephrol. 18(4):362-5, 2003
                                              26. Maturen KE et al: Computed tomographic diagnosis of unsuspected pyelonephritis in children. Can Assoc Radiol J. 53(5):279-83, 2002
                                              27. Kraus SJ: Genitourinary imaging in children. Pediatr Clin North Am. 48(6):1381-424, 2001
                                              28. Majd M et al: Acute pyelonephritis: comparison of diagnosis with 99mTc-DMSA, SPECT, spiral CT, MR imaging, and power Doppler US in an experimental pig model. Radiology. 218(1):101-8, 2001
                                              29. Pickhardt PJ et al: From the archives of the AFIP. Infiltrative renal lesions: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics. 20(1):215-43, 2000
                                              30. No authors listed: Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics. 103(4 Pt 1):843-52, 1999
                                              31. Roberts KB: A synopsis of the American Academy of Pediatrics' practice parameter on the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr Rev. 20(10):344-7, 1999
                                              32. Yen TC et al: Identification of new renal scarring in repeated episodes of acute pyelonephritis using Tc-99m DMSA renal SPECT. Clin Nucl Med. 23(12):828-31, 1998
                                              33. Kawashima A et al: CT of renal inflammatory disease. Radiographics. 17: 851-866, 1997
                                              34. Dacher JN et al: Power Doppler sonographic pattern of acute pyelonephritis in children: comparison with CT. AJR Am J Roentgenol. 166(6):1451-5, 1996
                                              35. Winters WD: Power Doppler sonographic evaluation of acute pyelonephritis in children. J Ultrasound Med. 15(2):91-6; quiz 97-8, 1996
                                              36. Talner LB et al: Acute pyelonephritis: can we agree on terminology? Radiology. 192:297-305, 1994
                                              37. Martinell J et al: Pregnancies in women with and without renal scarring after urinary infections in childhood. BMJ. 300(6728):840-4, 1990
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Definitions

                                                            • Acute infection of renal parenchyma

                                                          IMAGING

                                                          • General Features

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Nuclear Medicine Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Lee YJ et al: Unilateral and bilateral acute pyelonephritis: differences in clinical presentation, progress and outcome. Postgrad Med J. 90(1060):80-5, 2014
                                                                                          2. Vivier PH et al: MRI and suspected acute pyelonephritis in children: comparison of diffusion-weighted imaging with gadolinium-enhanced T1-weighted imaging. Eur Radiol. 24(1):19-25, 2014
                                                                                          3. De Pascale A et al: Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis. Eur Radiol. 23(11):3077-86, 2013
                                                                                          4. Faletti R et al: Diffusion-weighted imaging and apparent diffusion coefficient values versus contrast-enhanced MR imaging in the identification and characterisation of acute pyelonephritis. Eur Radiol. 23(12):3501-8, 2013
                                                                                          5. Ghasemi K et al: Correlation of 99mTc-DMSA scan with radiological and laboratory examinations in childhood acute pyelonephritis: a time-series study. Int Urol Nephrol. 45(4):925-32, 2013
                                                                                          6. Abraham G et al: Diagnosis of acute pyelonephritis with recent trends in management. Nephrol Dial Transplant. 27(9):3391-4, 2012
                                                                                          7. Rollino C et al: Acute pyelonephritis in adults: a case series of 223 patients. Nephrol Dial Transplant. 27(9):3488-93, 2012
                                                                                          8. Gupta K et al: International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 52(5):e103-20, 2011
                                                                                          9. Martina MC et al: Dynamic magnetic resonance imaging in acute pyelonephritis. Radiol Med. 115(2):287-300, 2010
                                                                                          10. Yoo JM et al: Diagnosing Acute Pyelonephritis with CT, Tc-DMSA SPECT, and Doppler Ultrasound: A Comparative Study. Korean J Urol. 51(4):260-5, 2010
                                                                                          11. Craig WD et al: Pyelonephritis: radiologic-pathologic review. Radiographics. 28(1):255-77; quiz 327-8, 2008
                                                                                          12. Mitterberger M et al: Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast-enhanced ultrasonography. BJU Int. 101(3):341-4, 2008
                                                                                          13. Demertzis J et al: State of the art: imaging of renal infections. Emerg Radiol. 14(1):13-22, 2007
                                                                                          14. Stunell H et al: Imaging of acute pyelonephritis in the adult. Eur Radiol. 17(7):1820-8, 2007
                                                                                          15. Pertel PE et al: Risk factors for a poor outcome after therapy for acute pyelonephritis. BJU Int. 98(1):141-7, 2006
                                                                                          16. Piccoli GB et al: Development of kidney scars after acute uncomplicated pyelonephritis: relationship with clinical, laboratory and imaging data at diagnosis. World J Urol. 24(1):66-73, 2006
                                                                                          17. Zissin R et al: Extrarenal manifestations of severe acute pyelonephritis: CT findings in 21 cases. Emerg Radiol. 13(2):73-7, 2006
                                                                                          18. Larcombe J: Urinary tract infection in children. Clin Evid. (14):429-40, 2005
                                                                                          19. Ramakrishnan K et al: Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician. 71(5):933-42, 2005
                                                                                          20. Sheffield JS et al: Urinary tract infection in women. Obstet Gynecol. 106(5 Pt 1):1085-92, 2005
                                                                                          21. Wang YT et al: Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol. 173(1):190-4; discussion 194, 2005
                                                                                          22. Fanos V et al: Antibiotics or surgery for vesicoureteric reflux in children. Lancet. 364(9446):1720-2, 2004
                                                                                          23. Foxman B et al: Acute pyelonephritis in US hospitals in 1997: hospitalization and in-hospital mortality. Ann Epidemiol. 13(2):144-50, 2003
                                                                                          24. Hoberman A et al: Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 348(3):195-202, 2003
                                                                                          25. Lin KY et al: Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection. Pediatr Nephrol. 18(4):362-5, 2003
                                                                                          26. Maturen KE et al: Computed tomographic diagnosis of unsuspected pyelonephritis in children. Can Assoc Radiol J. 53(5):279-83, 2002
                                                                                          27. Kraus SJ: Genitourinary imaging in children. Pediatr Clin North Am. 48(6):1381-424, 2001
                                                                                          28. Majd M et al: Acute pyelonephritis: comparison of diagnosis with 99mTc-DMSA, SPECT, spiral CT, MR imaging, and power Doppler US in an experimental pig model. Radiology. 218(1):101-8, 2001
                                                                                          29. Pickhardt PJ et al: From the archives of the AFIP. Infiltrative renal lesions: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics. 20(1):215-43, 2000
                                                                                          30. No authors listed: Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics. 103(4 Pt 1):843-52, 1999
                                                                                          31. Roberts KB: A synopsis of the American Academy of Pediatrics' practice parameter on the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr Rev. 20(10):344-7, 1999
                                                                                          32. Yen TC et al: Identification of new renal scarring in repeated episodes of acute pyelonephritis using Tc-99m DMSA renal SPECT. Clin Nucl Med. 23(12):828-31, 1998
                                                                                          33. Kawashima A et al: CT of renal inflammatory disease. Radiographics. 17: 851-866, 1997
                                                                                          34. Dacher JN et al: Power Doppler sonographic pattern of acute pyelonephritis in children: comparison with CT. AJR Am J Roentgenol. 166(6):1451-5, 1996
                                                                                          35. Winters WD: Power Doppler sonographic evaluation of acute pyelonephritis in children. J Ultrasound Med. 15(2):91-6; quiz 97-8, 1996
                                                                                          36. Talner LB et al: Acute pyelonephritis: can we agree on terminology? Radiology. 192:297-305, 1994
                                                                                          37. Martinell J et al: Pregnancies in women with and without renal scarring after urinary infections in childhood. BMJ. 300(6728):840-4, 1990