Clinical Usefulness of Unenhanced Computed Tomography in Patients with Acute Pyelonephritis.
10.3346/jkms.2018.33.e236
- Author:
Anna LEE
1
;
Hyo Cheol KIM
;
Sung Il HWANG
;
Ho Jun CHIN
;
Ki Young NA
;
Dong Wan CHAE
;
Sejoong KIM
Author Information
1. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. sejoong2@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Acute Pyelonephritis;
Unenhanced Computed Tomography;
Parenchymal Involvement;
Perinephric Infiltration;
Contrast-induced Nephropathy
- MeSH:
Acute Kidney Injury;
Diagnosis;
Emergency Service, Hospital;
Humans;
Hydronephrosis;
Male;
Mass Screening;
Nephrolithiasis;
Pyelonephritis*
- From:Journal of Korean Medical Science
2018;33(38):e236-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Unenhanced computed tomography (UCT) may be useful for evaluating acute pyelonephritis; however, no study has compared UCT with enhanced computed tomography (ECT) as a diagnostic tool. We evaluated a clinical usefulness of UCT versus ECT in acute pyelonephritis (APN). METHODS: We reviewed the clinical and radiological data from 183 APN-suspected patients who underwent UCT and ECT simultaneously at emergency room (ER) over a two-year period. Demographic, clinical parameters and computed tomography (CT) parameters of 149 patients were compared. RESULTS: The average patient age was 61.2 (± 10) years: 31 patients were men. Ninety-nine (66.4%) patients showed stones (18.7%), perinephric infiltration (56%), swelling (21%), and hydronephrosis (6.7%) on UCT. Seventeen patients (11.4%) had an atypical clinical course, requiring additional tests for accurate diagnosis. In 7 patients UCT and ECT results did not differ; in 10 patients, the diagnosis changed on ECT. On ECT, 112/149 (75.2%) patients had stones (16.7%), perinephric infiltrations (57%), swelling (21%), and hydronephrosis (6.7%); 62.5% showed parenchymal involvement: 34 (22.8%) patients had no abnormal ECT findings. APN CT findings are similar on stone, perinephric infiltration, swelling and hydronephrosis on both CTs. Twelve patients (8.0%) had an abnormal ECT finding, i.e., low-grade (1 and 2) parenchymal involvement. Six (4%) patients developed contrast-induced acute kidney injury within 2 days after ECT. CONCLUSION: We demonstrate that UCT is not inferior to ECT as an initial tool for evaluating APN for screening nephrolithiasis and hydronephrosis without the risk of contrast-induced acute kidney injury (CIAKI). However, patients with an atypical clinical course may still need ECT.
