PDF herunterladen
CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2020; 03(02): 126-136
DOI: 10.1055/s-0039-1695656
Review Article

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

Suman Hazarika
1   Department of Radiology, Apollo Hospitals Guwahati, Guwahati, Assam, India
,
Rochita Venkataramanan
2   Department of Radiology, Apollo Hospitals Chennai, Chennai, Tamil Nadu, India
,
Tonmoy Das
3   Department of Nephrology, Apollo Hospitals Guwahati, Guwahati, Assam, India
,
Sukanya Deuri
1   Department of Radiology, Apollo Hospitals Guwahati, Guwahati, Assam, India
,
Shalini Lohchab
1   Department of Radiology, Apollo Hospitals Guwahati, Guwahati, Assam, India
,
Tamsir Rongpipi
1   Department of Radiology, Apollo Hospitals Guwahati, Guwahati, Assam, India
,
Asish Agarwala
1   Department of Radiology, Apollo Hospitals Guwahati, Guwahati, Assam, India
,
Akash Venkataramanan
4   Medical school, Madras Medical College Chennai, Chennai, Tamil Nadu, India
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

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.

Keywords

acute pyelonephritis - papillary necrosis - pyonephrosis - renal abscess


Publikationsverlauf

Artikel online veröffentlicht:
24. September 2019

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Nicolle LE. Complicated pyelonephritis: unresolved issues. Curr Infect Dis Rep 2007; 9 (06) 501-507
    CrossrefPubMedGoogle Scholar
  • 2 Kawashima A, Sandler CM, Goldman SM. Imaging in acute renal infection. BJU Int 2000; 86 (Suppl. 01) 70-79
    PubMedGoogle Scholar
  • 3 Davidson AJ, Talner LB. Urographic and angiographic abnormalities in adult-onset acute bacterial nephritis. Radiology 1973; 106 (02) 249-256
    CrossrefPubMedGoogle Scholar
  • 4 Lee JK, McClennan BL, Melson GL, Stanley RJ. Acute focal bacterial nephritis: emphasis on gray scale sonography and computed tomography. AJR. Am J Roentgenol 1980; 135 (01) 87-92
    CrossrefPubMedGoogle Scholar
  • 5 Rosenfield AT, Glickman MG, Taylor KJ, Crade M, Hodson J. Acute focal bacterial nephritis (acute lobar nephronia). Radiology 1979; 132 (03) 553-561
    CrossrefPubMedGoogle Scholar
  • 6 Talner LB, Davidson AJ, Lebowitz RL, Dalla PalmaL, Goldman SM. Acute pyelonephritis: can we agree on terminology?. Radiology 1994; 192 (02) 297-305
    CrossrefPubMedGoogle Scholar
  • 7 Scholes D, Hooton TM, Roberts PL, Gupta K, Stapleton AE, Stamm WE. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med 2005; 142 (01) 20-27
    CrossrefGoogle Scholar
  • 8 Hill JB, Sheffield JS, McIntire DD, Wendel Jr GD. Acute pyelonephritis in pregnancy. Obstet Gynecol 2005; 105 (01) 18-23
    CrossrefPubMedGoogle Scholar
  • 9 Ulleryd P. Febrile urinary tract infection in men. Int J Antimicrob Agents 2003; 22 (Suppl. 02) 89-93
    CrossrefPubMedGoogle Scholar
  • 10 Cattell WR. Urinary tract infection and acute renal failure. In: Raine AE. eds. Advanced Renal Medicine. Oxford: Oxford University Press; 1992: 302-313
    Google Scholar
  • 11 Fulop T. Acute Pyelonephritis Workup. Aug 22, 2012. Available at: http://emedicine.medscape.com/article/245559-workup#aw2aab6b5b3. Accessed February 2015
  • 12 June CH, Browning MD, Smith LP. et al. Ultrasonography and computed tomography in severe urinary tract infection. Arch Intern Med 1985; 145 (05) 841-845
    CrossrefPubMedGoogle Scholar
  • 13 Soulen MC, Fishman EK, Goldman SM, Gatewood OM. Bacterial renal infection: role of CT. Radiology 1989; 171 (03) 703-707
    CrossrefPubMedGoogle Scholar
  • 14 Kawashima A, Sandler CM, Ernst RD, Goldman SM, Raval B, Fishman EK. Renal inflammatory disease: the current role of CT. Crit Rev Diagn Imaging 1997; 38 (05) 369-415
    PubMedGoogle Scholar
  • 15 Kawashima A, Sandler CM, Goldman SM. Current roles and controversies in the imaging evaluation of acute renal infection. World J Urol 1998; 16 (01) 9-17
    CrossrefPubMedGoogle Scholar
  • 16 Hoepelman AI, Meiland R, Geerlings SE. Pathogenesis and management of bacterial urinary tract infections in adult patients with diabetes mellitus. Int J Antimicrob Agents 2003; 22 (Suppl. 02) 35-43
    CrossrefPubMedGoogle Scholar
  • 17 Mitra S, Acharya H, Dua J. et al. 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. J Med Soc 2017; 31: 43-47
    CrossrefGoogle Scholar
  • 18 American College of Radiology. ACR Appropriateness criteria. Acute Pyelonephritis. Available at: https://acsearch.acr.org/docs/69489/Narrative/
  • 19 Demertzis J, Menias CO. State of the art: imaging of renal infections. Emerg Radiol 2007; 14 (01) 13-22
    CrossrefPubMedGoogle Scholar
  • 20 Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics 2008; 28 (01) 255-277, quiz 327–328
    CrossrefPubMedGoogle Scholar
  • 21 Vivier PH, Sallem A, Beurdeley M. et al. MRI and suspected acute pyelonephritis in children: comparison of diffusion-weighted imaging with gadolinium-enhanced T1-weighted imaging. Eur Radiol 2014; 24 (01) 19-25
    CrossrefPubMedGoogle Scholar
  • 22 Rathod SB, Kumbhar SS, Nanivadekar A, Aman K. Role of diffusion-weighted MRI in acute pyelonephritis: a prospective study. Acta Radiol 2015; 56 (02) 244-249
    CrossrefPubMedGoogle Scholar
  • 23 De Pascale A, Piccoli GB, Priola SM. et al. Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis. Eur Radiol 2013; 23 (11) 3077-3086
    CrossrefPubMedGoogle Scholar
  • 24 Chan JH, Tsui EY, Luk SH. et al. MR diffusion-weighted imaging of kidney: differentiation between hydronephrosis and pyonephrosis. Clin Imaging 2001; 25 (02) 110-113
    CrossrefPubMedGoogle Scholar
  • 25 Thoeny HC, De Keyzer F, Oyen RH, Peeters RR. Diffusion-weighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases: initial experience. Radiology 2005; 235 (03) 911-917
    CrossrefPubMedGoogle Scholar
  • 26 Stunell H, Buckley O, Feeney J, Geoghegan T, Browne RF, Torreggiani WC. Imaging of acute pyelonephritis in the adult. Eur Radiol 2007; 17 (07) 1820-1828
    CrossrefPubMedGoogle Scholar
  • 27 Taniguchi LS, Torres US, Souza SM, Torres LR, D'Ippolito G. Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?. Acta Radiol 2017; 58 (05) 634-640
    CrossrefPubMedGoogle Scholar
  • 28 Feldberg MA, Mali WP. An infected renal cyst. Urol Radiol 1980; 2 (01) 47-49
    CrossrefPubMedGoogle Scholar
  • 29 Frishman E, Orron DE, Heiman Z, Kessler A, Kaver I, Graif M. Infected renal cysts: sonographic diagnosis and management. J Ultrasound Med 1994; 13 (01) 7-10
    CrossrefPubMedGoogle Scholar
  • 30 Jung DC, Kim SH, Jung SI, Hwang SI, Kim SH. Renal papillary necrosis: review and comparison of findings at multi-detector row CT and intravenous urography. Radiographics 2006; 26 (06) 1827-1836
    CrossrefPubMedGoogle Scholar