Significance of echotomography in the diagnostic algorithm for acute pyelonephritis and glomerulonephritis

Ivan Bogosavljević Orcid logo ,
Ivan Bogosavljević
M. Gašić Orcid logo ,
M. Gašić
T. Filipović ,
T. Filipović
P. Mandić ,
P. Mandić
N. Đukić-Macut ,
N. Đukić-Macut
M. Šaranović ,
M. Šaranović
S. Stajić
S. Stajić

Published: 01.12.2015.

Volume 44, Issue 4 (2015)

pp. 11-16;

https://doi.org/10.5937/pramed1504011b

Abstract

Introduction: In adults the diagnosis of acute pyelonephritis and glomerulonephritis is primarily based on clinical and laboratory-biochemical testing. In patients where the clinical picture atypical, even if a person does not respond to therapy resorts to radiographic examination. Echotomographic examination is unavoidable in the diagnostic algorithm. Objective: The aim of this study was to establish the individual echotomographic parameters, as well as to determine their diagnostic power in patients with acute infections (pyelonephritis and glomerulonephritis), and comparing them with the appropriate reference tests. Materials and methods: We performed a cross sectional study in the period from October 2014. until May 2015. It included 50 patients with acute inflammation of the kidney which was made echotomographic examination of the abdomen and pelvis, within the Department of Radiological Diagnostics KBC "Dragisa Mišović-Dedinje" in Belgrade. The echotomographic examination of the kidneys included testing of numerous parameters that could indicate the existence of an acute inflammation of the kidney. For the gold standard, we take the findings obtained by CT (computed tomography) imaging of the abdomen and pelvis, as well as histopathological findings obtained by fine needle bio-psy. Results: At 50 patients with acute inflammation of the upper urinary tract, 41 patients (82%) had acute pyelonephritis, and 9 (18%) had acute glomerulonephritis. In 70% of patients with acute pyelonephritis (29 people) were present enlargement of the kidney where the test sensitivity was 79.3% and specificity of 91.7%. The accuracy of the method was 82.9% when the monitored parameters: loss of central echo complex and cortico-medullary differentiation. The sensitivity of the test in which the observed thickening of the pelvic and ureteric wall was 65% and specificity of 90%. The analysis of the presence of calculus in renal parenchyma leads to the values of sensitivity test of 54.8% and specificity of 80%. Hypoechoic focus in the renal parenchyma, enlargement of the kidneys and loss corticomedullar limits are parameters who with great sensitivity and specificity suggest acute glomerulonephritis. Conclusion: On the basis of high values of sensitivity and specificity of the test survey estimates that ultrasound has a required place in the following diagnostics algorithm. The use of echotomography that offer the possibility of high resolutive views, as well as the wide availability and good reproducibility of the method, the low cost of inspection, in favor of the first exploration ultrasound examination. Multidetector CT scan and fine needle biopsy remains the method of choice for the definitive diagnosis.

Keywords

References

1.
García-Ferrer L, Primo J, Escudero J, J, Domínguez O, Esteban F, et al. The use of renal ultrasound for adult acute pyelonephritisArch Esp Urol. 2007;(5):519–24.
2.
Stunell H, Buckley O, Feeney J, Geoghegan T, Browne R, Torreggiani W. Imaging of acute pyelonephritis in the adult. Eur Radiol. 2007;(7):1820–8.
3.
Parenti G, Passari A. Acute pyelonephritis. Role of diagnostic imaging. Radiol Med. 2001;(4):251–4.
4.
Wolters K, Herget-Rosenthal S, Langenbeck M. Nierensonographie. Der Internist. 2012;53(3):282–90.
5.
Mitterberger M, Pinggera G, Colleselli D, Bartsch G, Strasser H, Steppan I, et al. Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast-enhancedultrasonography. BJU Int. 2008;(3):341–4.
6.
Craig WD, Wagner BJ, Travis MD. Pyelonephritis: Radiologic-Pathologic Review. RadioGraphics. 2008;28(1):255–76.
7.
Diusiubaev A, Shalashov V. Thin needle aspiration biopsy of the kidneys in diagnosis of acute pyelonephritisUrologiia. 2007;(6):29–31.
8.
Ol ’, Eb. Ultrasound diagnosis of rare variants of acute urinary tract infection in childrenVestn Rentgenol Radiol. 2012;(6):13–8.
9.
Mitterberger M, Pinggera G, Feuchtner G, Neururer R, Bartsch G, Gradl J, et al. Frauscher FSonographic renal pelvis wall thickness as diagnostic criterion for acute pyelonephritis in adults. Ultraschall Med. 2007;(6):593–7.
10.
Wang Y, Chiu N, Chen M, Huang J, Chou H. Chiou YYCorrelation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol. 2005;(1):190–4.
11.
Shajari A, Nafisi-Moghadam R, Smaili M, Fallah A, Pahlusi M, A. Renal power Doppler ultrasonographic evaluation of children with acute pyelonephritis. Acta Med Iran. 2011;(10):659–62.
12.
Mohammadjafari H, Aalaee A, Salehifar E, Shiri A, Khademloo M. Shahmohammadi SDoppler ultrasonography as a predictive tool for permanent kidney damage following acute pyelonephritis: comparison with dimercaptosuccinic acid scintigraphy. Iran J Kidney Dis. 2011;(6):386–91.
13.
Dell’atti L, Borea P, Ughi G. Russo GRClinical use of ultrasonography associated with color Doppler in the diagnosis and follow-up of acutepyelonephritis. Arch Ital Urol Androl. 2010;(4):217–20.
14.
Sakarya M, Arslan H, Erkoç R, Bozkurt M, Atilla M. The role of power Doppler ultrasonography in the diagnosis of acute pyelonephritisBr J Urol. 1998;(3):360–3.
15.
Berro Y, Baratte B, Seryer D, Boulu G, Slama M, Boudailliez B, et al. Comparison between scintigraphy, B-mode, and power Doppler sonography in acute pyelonephritis in childrenJ Radiol. 2000;(5):523–7.
16.
Granata A, Floccari F, Insalaco M, Clementi A, Lullo D, L, et al. Ultrasound assessment in renal infections. G Ital Nefrol. 2012;
17.
Yamaguchi S, Fujii H, Kaneko S, Yachiku S, Inada F, Anzai T, et al. Ishida HUltrasonographic study on kidneys in patients with acute renal failure. Nihon Hinyokika Gakkai Zasshi. 1991;(10):1561–7.
18.
Printza N, Bosdou J, Pantzaki A, Badouraki M, Kollios K, Ch G, et al. Percutaneous ultrasound-guided renal biopsy in children: a single centre experience. Hippokratia. 2011;(3):258–61.
19.
Horvatić I, Hrkać A, Zivko M, Kozjak D, Galesić K. Value of ultrasound-guided percutaneous renal biopsy in diagnosis of the renal diseases. Acta Med Croatica. 2007;(4):399–403.

Citation

Copyright

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Most read articles

Indexed by