Pyelonephritis other diagnostic studies: Difference between revisions
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==Overview== | ==Overview== | ||
Other diagnostic studies for pyelonephritis include contrast nephrograms, intravenous pyleography, voiding cystourethrogram, dimercaptosuccinic acid scintigraphy, histopathological exam, and urography. | |||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
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[[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> | [[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> | ||
===Histopathological | ===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.<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> | 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> | ||
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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 contrast nephrograms, intravenous pyleography, voiding cystourethrogram, dimercaptosuccinic acid scintigraphy, histopathological exam, and urography.
Other Diagnostic Studies
Contrast Nephrograms
Acute Pyelonephritis
- 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 a very sensitive readiological test and is performed to diagnose an intrarenal or perinephric abscesses. It can also be used to assess the normal functioning of the urinary passage.[1]
Voiding cystourethrogram (VCUG)
A VCUG is an x ray image of the bladder and urethra taken while the bladder is full and during urination (also known as 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. The bladder and urethra are filled with contrast medium to make the structures clearly visible on the radiographs. The x ray machine captures images of the contrast medium while the bladder is full and when the person urinates. This test can demonstrate abnormalities of the inside of the urethra and bladder and is usually used to detect VUR in children.[2]
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.[3][4][5]
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.[6]
Urography
Urography can be used to diagnose patients with acute pyelonephritis and in some cases with xanthogranulomatous pyelonephritis:[7]
- 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
- ↑ Hoverman IV, Gentry LO, Jones DW, Guerriero WG (1980). "Intrarenal abscess. Report of 14 cases". Arch Intern Med. 140 (7): 914–6. PMID 6992728.
- ↑ Yousefichaijan P, Dorreh F, Shahsavari S, Pakniyat A (2016). "Comparing between results and complications of doing voiding cystourethrogram in the first week following urinary tract infection and in 2-6 weeks after urinary tract infection in children referring to a teaching hospital". J Renal Inj Prev. 5 (3): 144–7. doi:10.15171/jrip.2016.30. PMC 5040001. PMID 27689111.
- ↑ 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.
- ↑ 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.
- ↑ Kawashima A, LeRoy AJ (2003). "Radiologic evaluation of patients with renal infections". Infect Dis Clin North Am. 17 (2): 433–56. PMID 12848478.
- ↑ 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.
- ↑ Sandberg T, Stokland E, Brolin I, Lidin-Janson G, Svanborg Edén C (1989). "Selective use of excretory urography in women with acute pyelonephritis". J Urol. 141 (6): 1290–4. PMID 2724423.