Pyelonephritis diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Diagnostic Study of Choice
Study of choice
- 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.
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 | + | 74-96% | 94-98% | |
| Nitrite test | + | 35-85% | 92-100% | |
| Combination leukocyte esterase and nitrite tests | Either test + | 75-84% | 82-98% | |
| Gram stain of uncentrifuged urine | > 1 bacterium per HPF | 93% | 95% | |
| Urine culture | + | 90% | ||
| Blood culture | + | 20% | ||