Pyelonephritis other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Other investigations might be used to diagnose pyelonephritis. Contrast nephrograms, intravenous pyelography, and urography are helpful in diagnosing pyelonephritis and its complications.

Other Imaging Findings

Other investigations might be used to diagnose pyelonephritis.

Contrast Nephrograms

• Acute pyelonephritis consists of focal areas of striated or wedge-shaped hypoperfusion, resulting in a characteristic striated nephrogram.
• Striations result from stasis of contrast material within edematous tubules that demonstrates increasing attenuation over time.
• The infected kidney is usually enlarged, and there is often stranding in the perinephric fat.
• Delayed views of the infected kidney may demonstrate a nephrogram with increased attenuation.

Intravenous Pyelography

• Intravenous pyelography (IVP) is done to diagnose an intrarenal or perinephric abscesses. IVP is a very sensitive radiological test for this purpose.

Urography

• Urography can be used to diagnose patients with acute pyelonephritis and in some cases with xanthogranulomatous pyelonephritis.

• Classic urographic triad in diffuse xanthogranulomatous pyelonephritis consists of:
  • Unilaterally decreased or (more commonly) absent renal excretion
  • A staghorn calculus
  • Poorly defined mass or diffuse renal enlargement
• Failure to respond to antibiotic therapy or recurrence of symptoms may be taken as an indication to perform urography.