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
- There is no single diagnostic study of choice for 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.
- Urinalysis and urine culture with susceptibility testing might support the diagnosis.
- Imaging would not be necessary for patients with pyelonephritis, unless in patients with severe and refractory illness or suspected urinary tract obstruction.
- There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
- [Disease name] is mainly diagnosed based on clinical presentation.
- Investigations:
- Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
- Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
- Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
The comparison of various diagnostic studies for [disease name]
| Test | Sensitivity | Specificity | |
|---|---|---|---|
| Urinalysis | > 5 WBCs/HPF | 72-95% | 48-82% |
| > 10 WBCs/HPF | 58-82% | 65-86% | |
| Positive RBC | 44% | 88% | |
| Leukocyte esterase test | Positive | 74-96% | 94-98% |
| Nitrite test | Positive | 35-85% | 92-100% |
| Combination leukocyte esterase and nitrite tests | Either test positive | 75-84% | 82-98% |
| Gram stain of uncentrifuged urine | > 1 bacterium per HPF | 93% | 95% |
Diagnostic results
The following result of [investigation name] is confirmatory of [disease name]:
- Result 1
- Result 2
Sequence of Diagnostic Studies
The [name of investigation] should be performed when:
- The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
- A positive [test] is detected in the patient, to confirm the diagnosis.
Diagnostic Criteria
- Here you should describe the details of the diagnostic criteria.
- Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
- Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
- Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
- Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
- To view an example (endocarditis diagnostic criteria), click here
- If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
- You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
- [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
- There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
- [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
- Criteria 1
- Criteria 2
- Criteria 3
IF there are clear, established diagnostic criteria:
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
- The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria:
- There are no established criteria for the diagnosis of [disease name].