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{{Pyelonephritis}}
{{Pyelonephritis}}
{{CMG}}; {{AE}} {{USAMA}}


{{CMG}}
==Overview==
Other diagnostic studies for pyelonephritis include dimercaptosuccinic acid scintigraphy and histopathological exam.


==Other Diagnostic Studies==
==Other Diagnostic Studies==
===Contrast Nephrograms===
===Renal biopsy===
====Acute Pyelonephritis====
*A [[biopsy]] can be done to confirm the diagnosis of a complex [[renal]] pathology or to check the extent and type of damage to the [[kidney]].
*Acute pyelonephritis consists of focal areas of striated or wedge-shaped [[hypoperfusion]], resulting in a characteristic striated nephrogram.  
*It is used specifically in case of xanthogranulomatous pyelonephritis that is confused with renal tumors usually [[Wilms' tumor|Wilm's tumor]].
*Striations result from stasis of contrast material within edematous tubules that demonstrates increasing attenuation over time.
*The histopathological exam of the [[biopsy]] specimen confirm xanthogranulomatous type of pyelonephritis.
*The infected kidney is usually enlarged, and there is often stranding in the [[perinephric fat]].  
===Dimercaptosuccinic acid (DMSA) scintigraphy===
*Delayed views of the infected kidney may demonstrate a nephrogram with increased attenuation.
[[DMSA]] [[scintigraphy]] is based on the identification of radiation in minute quantities after injecting a radioactive material. Since the radioactive material is used in a minute quantity, there is less risk of cell damage. It can be performed in an outpatient or inpatient setting by qualified personnel. This investigation can be carried out in the absence of anesthesia. Radioactive substance injected  an arm vein reaches the kidneys. Attached cameras create images of the path taken by the radioactive substance. The effected parts of the kidney become prominent. [[DMSA]] [[scintigraphy]] shows the extent of kidney involvement. Cortical Scintigraphy is preferred for the diagnosis of acute pyelonephritis in children.<ref name="pmid27604130">{{cite journal| author=Salihoglu YS, Elri T, Gulle K, Can M, Aras M, Ozacmak HS et al.| title=Evaluation of the protective effect of agmatine against cisplatin nephrotoxicity with 99mTc-DMSA renal scintigraphy and cystatin-C. | journal=Ren Fail | year= 2016 | volume= 38 | issue= 9 | pages= 1496-1502 | pmid=27604130 | doi=10.1080/0886022X.2016.1227919 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27604130  }} </ref><ref name="pmid8283371">{{cite journal| author=Benador D, Benador N, Slosman DO, Nusslé D, Mermillod B, Girardin E| title=Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. | journal=J Pediatr | year= 1994 | volume= 124 | issue= 1 | pages= 17-20 | pmid=8283371 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8283371  }} </ref><ref name="pmid12848478">{{cite journal| author=Kawashima A, LeRoy AJ| title=Radiologic evaluation of patients with renal infections. | journal=Infect Dis Clin North Am | year= 2003 | volume= 17 | issue= 2 | pages= 433-56 | pmid=12848478 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12848478 }} </ref>
====Intravenous Pyelography====
Intravenous Pyelography (IVP) is done to diagnose an intra-renal or peri-nephric abscesses. IVP is a very sensitive radiological test for this purpose It can also be used to assess the normal functioning of the urinary passage.<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>


===Voiding cystourethrogram (VCUG)===
===Histopathological exam===
A VCUG is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. The procedure is performed in an outpatient center or hospital by an x-ray technician supervised by a radiologist, who then interprets the images. Anesthesia is not needed, but sedation may be used for some people. The bladder and urethra are filled with contrast medium to make the structures clearly visible on the x-ray images. The x-ray machine captures images of the contrast medium while the bladder is full and when the person urinates. This test can show abnormalities of the inside of the urethra and bladder and is usually used to detect [[VUR]] in children.
Xanthoranulomatous pyelonephritis is usually confused with a [[malignancy]] and surgery is performed. The histopathological examination of the resected specimen confirms xanthogranulomatous pyelonephritis which is not a very common phenomenon. Microscopic examination after performing [[biopsy]] shows the inflammatory mass composed of [[lipid-laden]] [[macrophages]] and chronic inflammatory cells.<ref name="pmid27915241">{{cite journal| author=Yeow Y, Chong YL| title=Xanthogranulomatous pyelonephritis presenting as Proteus preperitoneal abscess. | journal=J Surg Case Rep | year= 2016 | volume= 2016 | issue= 12 | pages=  | pmid=27915241 | doi=10.1093/jscr/rjw211 | pmc=5159021 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27915241  }} </ref>
===Dimercaptosuccinic acid (DMSA) scintigraphy===
 
DMSA scintigraphy is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive material. Because the dose of radioactive material is small, the risk of causing damage to cells is low. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist. Anesthesia is not needed. Radioactive material is injected into a vein in the person’s arm and travels through the body to the kidneys. Special cameras and computers are used to create images of the radioactive material as it passes through the kidneys. The radioactive material makes the parts of the kidney that are infected or scarred stand out on the image. DMSA scintigraphy is used to show the severity of kidney infection or kidney damage, such as scarring.
 
===Histopathological Exam===
Xanthoranulomatous Pyelonephritis is usually confused with a malignancy and surgery is performed. The histopathological examination of the resected specimen confirms xanthogranulomatous pyelonephritis which is not a very common phenomenon.<ref name="pmid27915241">{{cite journal| author=Yeow Y, Chong YL| title=Xanthogranulomatous pyelonephritis presenting as Proteus preperitoneal abscess. | journal=J Surg Case Rep | year= 2016 | volume= 2016 | issue= 12 | pages=  | pmid=27915241 | doi=10.1093/jscr/rjw211 | pmc=5159021 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27915241  }} </ref>
 
===Cortical Scintigraphy===
Cortical Scintigraphy is preferred for the diagnosis of acute pyelonephritis in children.<ref name="pmid12848478">{{cite journal| author=Kawashima A, LeRoy AJ| title=Radiologic evaluation of patients with renal infections. | journal=Infect Dis Clin North Am | year= 2003 | volume= 17 | issue= 2 | pages= 433-56 | pmid=12848478 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12848478  }} </ref>
 
 
===Urography===
Urography can be used to diagnose patients with acute pyelonephritis and in some cases with xanthogranulomatous pyelonephritis<ref name="pmid2724423">{{cite journal| author=Sandberg T, Stokland E, Brolin I, Lidin-Janson G, Svanborg Edén C| title=Selective use of excretory urography in women with acute pyelonephritis. | journal=J Urol | year= 1989 | volume= 141 | issue= 6 | pages= 1290-4 | pmid=2724423 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2724423  }} </ref>
* Classic urographic triad in diffuse xanthogranulomatous pyelonephritis consists of unilaterally decreased or (more commonly) absent renal excretion, a staghorn calculus, and a 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


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Medicine]]
[[Category:Infectious disease]]
[[Category:Nephrology]]
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[[Category:Inflammations]]
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[[Category:Primary care]]
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Latest revision as of 23:54, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Other diagnostic studies for pyelonephritis include dimercaptosuccinic acid scintigraphy and histopathological exam.

Other Diagnostic Studies

Renal biopsy

  • A biopsy can be done to confirm the diagnosis of a complex renal pathology or to check the extent and type of damage to the kidney.
  • It is used specifically in case of xanthogranulomatous pyelonephritis that is confused with renal tumors usually Wilm's tumor.
  • The histopathological exam of the biopsy specimen confirm xanthogranulomatous type of pyelonephritis.

Dimercaptosuccinic acid (DMSA) scintigraphy

DMSA scintigraphy is based on the identification of radiation in minute quantities after injecting a radioactive material. Since the radioactive material is used in a minute quantity, there is less risk of cell damage. It can be performed in an outpatient or inpatient setting by qualified personnel. This investigation can be carried out in the absence of anesthesia. Radioactive substance injected an arm vein reaches the kidneys. Attached cameras create images of the path taken by the radioactive substance. The effected parts of the kidney become prominent. DMSA scintigraphy shows the extent of kidney involvement. Cortical Scintigraphy is preferred for the diagnosis of acute pyelonephritis in children.[1][2][3]

Histopathological exam

Xanthoranulomatous pyelonephritis is usually confused with a malignancy and surgery is performed. The histopathological examination of the resected specimen confirms xanthogranulomatous pyelonephritis which is not a very common phenomenon. Microscopic examination after performing biopsy shows the inflammatory mass composed of lipid-laden macrophages and chronic inflammatory cells.[4]

References

  1. Salihoglu YS, Elri T, Gulle K, Can M, Aras M, Ozacmak HS; et al. (2016). "Evaluation of the protective effect of agmatine against cisplatin nephrotoxicity with 99mTc-DMSA renal scintigraphy and cystatin-C". Ren Fail. 38 (9): 1496–1502. doi:10.1080/0886022X.2016.1227919. PMID 27604130.
  2. Benador D, Benador N, Slosman DO, Nusslé D, Mermillod B, Girardin E (1994). "Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis". J Pediatr. 124 (1): 17–20. PMID 8283371.
  3. Kawashima A, LeRoy AJ (2003). "Radiologic evaluation of patients with renal infections". Infect Dis Clin North Am. 17 (2): 433–56. PMID 12848478.
  4. Yeow Y, Chong YL (2016). "Xanthogranulomatous pyelonephritis presenting as Proteus preperitoneal abscess". J Surg Case Rep. 2016 (12). doi:10.1093/jscr/rjw211. PMC 5159021. PMID 27915241.

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