Pyelonephritis refers to infection involving the renal parenchyma and renal pelvis. In most patients, uncomplicated pyelonephritis is diagnosed clinically and responds quickly to appropriate antibiotic treatment. If treatment is delayed, the patient is immunocompromised, or for other reasons, microabscesses that form during the acute phase of pyelonephritis may coalesce, forming a renal abscess. Patients with underlying diabetes are more vulnerable to complications, including emphysematous pyelonephritis in addition to abscess formation. Additionally, diabetics may not have the typical flank tenderness that helps to differentiate pyelonephritis from a lower urinary tract infection. Additional high-risk populations may include those with anatomic abnormalities of the urinary tract, vesicoureteral reflux, obstruction, pregnancy, nosocomial infection, or infection by treatment-resistant pathogens. Treatment goals include symptom relief, elimination of infection to avoid renal damage, and identification of predisposing factors to avoid future recurrences. The primary imaging modalities used in patients with pyelonephritis are CT, MRI, and ultrasound. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Journal of the American College of Radiology : JACR. 2018 Nov [Epub]
Expert Panel on Urologic Imaging: , Paul Nikolaidis, Vikram S Dogra, Stanley Goldfarb, John L Gore, Howard J Harvin, Marta E Heilbrun, Matthew T Heller, Gaurav Khatri, Andrei S Purysko, Stephen J Savage, Andrew D Smith, Myles T Taffel, Zhen J Wang, Darcy J Wolfman, Jade J Wong-You-Cheong, Don C Yoo, Mark E Lockhart
Panel Chair, Northwestern University, Chicago, Illinois. Electronic address: ., University of Rochester Medical Center, Rochester, New York., University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology., University of Washington, Seattle, Washington; American Urological Association., Scottsdale Medical Imaging, Scottsdale, Arizona., Emory University School of Medicine, Atlanta, Georgia., University of Pittsburgh, Pittsburgh, Pennsylvania., UT Southwestern Medical Center, Dallas, Texas., Cleveland Clinic, Cleveland, Ohio., Medical University of South Carolina, Charleston, South Carolina; American Urological Association., University of Alabama at Birmingham Medical Center, Birmingham, Alabama., New York University, New York, New York., University of California San Francisco School of Medicine, San Francisco, California., Johns Hopkins University School of Medicine, Washington, District of Columbia., University of Maryland School of Medicine, Baltimore, Maryland., Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island., Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama.