The role of emergency ultrasound for evaluating acute pyelonephritis in the ED

Kuo Chih Chen, Shih Wen Hung, Vei Ken Seow, Chee Fah Chong, Tzong Luen Wang, Yu Chuan Li, Hang Chang

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Controversy remains over the imaging method of choice for evaluating acute pyelonephritis (APN) in the emergency department (ED). Objective: The aim of the study was to determine the efficacy of ultrasound in the diagnosis and management of patients presented to the ED with APN. Methods: This was a retrospective study of prospectively collected data. A cohort of ED patients diagnosed as APN were prospectively registered, and their medical records were then retrospectively reviewed for the presence of complications (admitted >14 days, admission to intensive care unit, or received invasive procedures), significant abnormalities (hydronephrosis, polycystic kidney diseases, renal abscess, emphysematous pyelonephritis), and mild abnormalities (cysts, stones, swelling). Results: The study included 243 patients. Most of the patients received one or more renal imaging studies (n = 206) and 39.5% of which were considered abnormal. The rates of significant abnormalities on different imaging methods were Kidney-ureter-bladder (KUB), 16.3%; emergency ultrasound (EUS), 39.6%; combination of KUB and EUS, 56.6%; and computed tomography, 58.8%. Factors contributed to complicated APN were elderly, male, a history of preexisting renal diseases, current use of catheters, previous renal calculi, and diabetes mellitus. Significant abnormalities can be identified by EUS in 61% of patients with complicated APN. In fact, the presence of significant sonographic abnormalities effectively diverted 34.3% of patients to receive surgical interventions (percutaneous nephrostomy, abscess aspiration, ureteroscopic stone manipulation, lithotripsy, or nephrectomy). Conclusion: Structural abnormalities are not uncommon in ED patients with APN. Early assessment of these patients with EUS is likely to have a great impact on their diagnosis and management.

Original languageEnglish
Pages (from-to)721-724
Number of pages4
JournalAmerican Journal of Emergency Medicine
Volume29
Issue number7
DOIs
Publication statusPublished - Sep 2011

ASJC Scopus subject areas

  • Emergency Medicine

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