Pyelonephritis diagnostic study of choice: Difference between revisions
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{{Pyelonephritis}} | {{Pyelonephritis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{SSH}} | ||
== Overview == | == Overview == | ||
[[Urine|Urinalysis]] and [[urine culture]] with susceptibility testing might confirm the diagnosis of pyelonephritis. Pyelonephritis must be suspected if the patient has urinary symptoms including [[dysuria]], [[Urinary urgency|urgency]], [[frequency]], or suprapubic [[pain]], along with [[fever]], [[Rigor|chills]], [[flank pain]], [[Pelvis|pelvic]] or perineal [[pain]]. [[Imaging]] would not be necessary for patients with pyelonephritis, unless in patients with severe and refractory illness or suspected [[Obstructive uropathy|urinary tract obstruction]]. | |||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
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=== Study of choice === | === Study of choice === | ||
* [[Urine|Urinalysis]] and [[urine culture]] with susceptibility testing might confirm the diagnosis of pyelonephritis.<ref name="pmid15768623">{{cite journal| author=Ramakrishnan K, Scheid DC| title=Diagnosis and management of acute pyelonephritis in adults. | journal=Am Fam Physician | year= 2005 | volume= 71 | issue= 5 | pages= 933-42 | pmid=15768623 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15768623 }} </ref><ref name="pmid6992728">{{cite journal| author=Hoverman IV, Gentry LO, Jones DW, Guerriero WG| title=Intrarenal abscess. Report of 14 cases. | journal=Arch Intern Med | year= 1980 | volume= 140 | issue= 7 | pages= 914-6 | pmid=6992728 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6992728 }} </ref><ref name="pmid21292654">{{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=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. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654 }} </ref> | * [[Urine|Urinalysis]] and [[urine culture]] with susceptibility testing might confirm the diagnosis of pyelonephritis.<ref name="pmid15768623">{{cite journal| author=Ramakrishnan K, Scheid DC| title=Diagnosis and management of acute pyelonephritis in adults. | journal=Am Fam Physician | year= 2005 | volume= 71 | issue= 5 | pages= 933-42 | pmid=15768623 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15768623 }} </ref><ref name="pmid6992728">{{cite journal| author=Hoverman IV, Gentry LO, Jones DW, Guerriero WG| title=Intrarenal abscess. Report of 14 cases. | journal=Arch Intern Med | year= 1980 | volume= 140 | issue= 7 | pages= 914-6 | pmid=6992728 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6992728 }} </ref><ref name="pmid21292654">{{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=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. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654 }} </ref> | ||
* Pyelonephritis must be suspected if the patient has urinary symptoms including dysuria, urgency, frequency, or suprapubic pain, along with fever, chills, flank pain, pelvic or perineal pain. | * Pyelonephritis must be suspected if the patient has urinary symptoms including [[dysuria]], [[Urinary urgency|urgency]], [[frequency]], or suprapubic [[pain]], along with [[fever]], [[Rigor|chills]], [[flank pain]], [[Pelvis|pelvic]] or perineal [[pain]]. | ||
* Imaging would not be necessary for patients with pyelonephritis, unless in patients with severe and refractory illness or suspected urinary tract obstruction. | * [[Imaging]] would not be necessary for patients with pyelonephritis, unless in patients with severe and refractory illness or suspected [[Obstructive uropathy|urinary tract obstruction]]. | ||
==== The comparison of various diagnostic studies for pyelonephritis ==== | ==== The comparison of various diagnostic studies for pyelonephritis ==== | ||
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[[Category:Medicine]] | |||
[[Category:Infectious disease]] | |||
[[Category:Nephrology]] | |||
[[Category:Urology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Emergency medicine]] | |||
Latest revision as of 23:54, 29 July 2020
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Pyelonephritis diagnostic study of choice On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Urinalysis and urine culture with susceptibility testing might confirm the diagnosis of pyelonephritis. Pyelonephritis must be suspected if the patient has urinary symptoms including dysuria, urgency, frequency, or suprapubic pain, along with fever, chills, flank pain, pelvic or perineal pain. Imaging would not be necessary for patients with pyelonephritis, unless in patients with severe and refractory illness or suspected urinary tract obstruction.
Diagnostic Study of Choice
Study of choice
- Urinalysis and urine culture with susceptibility testing might confirm the diagnosis of pyelonephritis.[1][2][3]
- Pyelonephritis must be suspected if the patient has urinary symptoms including dysuria, urgency, frequency, or suprapubic pain, along with fever, chills, flank pain, pelvic or perineal pain.
- Imaging would not be necessary for patients with pyelonephritis, unless in patients with severe and refractory illness or suspected urinary tract obstruction.
The comparison of various diagnostic studies for pyelonephritis
| Test | Sensitivity | Specificity | ||
|---|---|---|---|---|
| Urinalysis | WBC | > 5 WBCs/HPF | 72-95% | 48-82% |
| > 10 WBCs/HPF | 58-82% | 65-86% | ||
| RBC | + | 44% | 88% | |
| Leukocyte esterase test (LET) | + | 74-96% | 94-98% | |
| Nitrite test (NPT) | + | 35-85% | 92-100% | |
| Combined leukocyte esterase-nitrite tests | Either test + | 75-84% | 82-98% | |
| Gram stain of uncentrifuged urine | > 1 bacterium per HPF | 93% | 95% | |
| Urinary neutrophil gelatinase-associated lipocalin (NGAL) | > 29.4 ng/mL | 92.5% | 90.7% | |
| > 7.32 ng/ml | 81.3% | 66% | ||
| Urine culture | + | 90% | ||
| Blood culture | + | 20% | ||
References
- ↑ Ramakrishnan K, Scheid DC (2005). "Diagnosis and management of acute pyelonephritis in adults". Am Fam Physician. 71 (5): 933–42. PMID 15768623.
- ↑ Hoverman IV, Gentry LO, Jones DW, Guerriero WG (1980). "Intrarenal abscess. Report of 14 cases". Arch Intern Med. 140 (7): 914–6. PMID 6992728.
- ↑ Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG; et al. (2011). "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. doi:10.1093/cid/ciq257. PMID 21292654.