Pyelonephritis diagnostic study of choice: Difference between revisions

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Latest revision as of 23:54, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Urinalysis and urine culture with susceptibility testing might confirm 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. Imaging would not be necessary for patients with pyelonephritis, unless in patients with severe and refractory illness or suspected urinary tract obstruction.

Diagnostic Study of Choice

Study of choice

Urinalysis and urine culture with susceptibility testing might confirm the diagnosis of pyelonephritis.^[1]^[2]^[3]
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.
Imaging would not be necessary for patients with pyelonephritis, unless in patients with severe and refractory illness or suspected urinary tract obstruction.

The comparison of various diagnostic studies for pyelonephritis

Test			Sensitivity	Specificity
Urinalysis	WBC	> 5 WBCs/HPF	72-95%	48-82%
	WBC	> 10 WBCs/HPF	58-82%	65-86%
	RBC	+	44%	88%
	Leukocyte esterase test (LET)	+	74-96%	94-98%
	Nitrite test (NPT)	+	35-85%	92-100%
	Combined leukocyte esterase-nitrite tests	Either test +	75-84%	82-98%
	Gram stain of uncentrifuged urine	> 1 bacterium per HPF	93%	95%
	Urinary neutrophil gelatinase-associated lipocalin (NGAL)	> 29.4 ng/mL	92.5%	90.7%
	Urinary neutrophil gelatinase-associated lipocalin (NGAL)	> 7.32 ng/ml	81.3%	66%
Urine culture		+	90%
Blood culture		+	20%

References

↑ Ramakrishnan K, Scheid DC (2005). "Diagnosis and management of acute pyelonephritis in adults". Am Fam Physician. 71 (5): 933–42. PMID 15768623.
↑ Hoverman IV, Gentry LO, Jones DW, Guerriero WG (1980). "Intrarenal abscess. Report of 14 cases". Arch Intern Med. 140 (7): 914–6. PMID 6992728.
↑ Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG; et al. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654.

Template:WH Template:WS

[pmid15768623-1] Ramakrishnan K, Scheid DC (2005). "Diagnosis and management of acute pyelonephritis in adults". Am Fam Physician. 71 (5): 933–42. PMID 15768623.

[pmid6992728-2] Hoverman IV, Gentry LO, Jones DW, Guerriero WG (1980). "Intrarenal abscess. Report of 14 cases". Arch Intern Med. 140 (7): 914–6. PMID 6992728.

[pmid21292654-3] Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG; et al. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654.

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Pyelonephritis}}
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}} {{SSH}}
 == Overview ==
+[[Urine|Urinalysis]] and [[urine culture]] with susceptibility testing might confirm the diagnosis of pyelonephritis. Pyelonephritis must be suspected if the patient has urinary symptoms including [[dysuria]], [[Urinary urgency|urgency]], [[frequency]], or suprapubic [[pain]], along with [[fever]], [[Rigor|chills]], [[flank pain]], [[Pelvis|pelvic]] or perineal [[pain]]. [[Imaging]] would not be necessary for patients with pyelonephritis, unless in patients with severe and refractory illness or suspected [[Obstructive uropathy|urinary tract obstruction]].
 == Diagnostic Study of Choice ==
 === Study of choice ===
-* There is no single diagnostic study of choice for the diagnosis of pyelonephritis.
+* [[Urine|Urinalysis]] and [[urine culture]] with susceptibility testing might confirm the diagnosis of pyelonephritis.<ref name="pmid15768623">{{cite journal| author=Ramakrishnan K, Scheid DC| title=Diagnosis and management of acute pyelonephritis in adults. | journal=Am Fam Physician | year= 2005 | volume= 71 | issue= 5 | pages= 933-42 | pmid=15768623 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15768623  }} </ref><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><ref name="pmid21292654">{{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654  }} </ref>
-* 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.
+* Pyelonephritis must be suspected if the patient has urinary symptoms including [[dysuria]], [[Urinary urgency|urgency]], [[frequency]], or suprapubic [[pain]], along with [[fever]], [[Rigor|chills]], [[flank pain]], [[Pelvis|pelvic]] or perineal [[pain]].
-* [[Urine|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 [[Obstructive uropathy|urinary tract obstruction]].
-* 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] ====
+==== The comparison of various diagnostic studies for pyelonephritis ====
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
@@ Line 25: / Line 19: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
 |-
-! rowspan="7" style="background: #696969; color: #FFFFFF; text-align: center;" |Urinalysis
+! rowspan="9" style="background: #696969; color: #FFFFFF; text-align: center;" |Urinalysis
 ! rowspan="2" style="background: #696969; color: #FFFFFF; text-align: center;" |WBC
 | colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |> 5 WBCs/HPF
@@ Line 36: / Line 30: @@
 |-
 ! style="background: #696969; color: #FFFFFF; text-align: center;" |RBC
-| colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |+
+| colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" | +
 | colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |44%
 | colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |88%
 |-
-! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Leukocyte esterase test
+! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Leukocyte esterase test (LET)
 | colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" | +
 | colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |74-96%
 | colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |94-98%
 |-
-! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Nitrite test
+! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Nitrite test (NPT)
 | colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" | +
 | colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |35-85%
 | colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |92-100%
 |-
-! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Combination leukocyte esterase and nitrite tests
+! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Combined leukocyte esterase-nitrite tests
 | colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Either test +
 | colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |75-84%
@@ Line 59: / Line 53: @@
 | colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |93%
 | colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |95%
+|-
+! rowspan="2" style="background: #696969; color: #FFFFFF; text-align: center;" |Urinary neutrophil gelatinase-associated lipocalin (NGAL)
+| style="background: #696969; color: #FFFFFF; text-align: center;" |> 29.4 ng/mL
+| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |92.5%
+| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |90.7%
+|-
+| style="background: #696969; color: #FFFFFF; text-align: center;" |> 7.32 ng/ml
+| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |81.3%
+| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |66%
 |-
 ! colspan="2" style="background: #696969; color: #FFFFFF; text-align: center;" |Urine culture
-| style="background: #696969; color: #FFFFFF; text-align: center;" |+
+| style="background: #696969; color: #FFFFFF; text-align: center;" | +
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |90%
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |
 |-
 ! colspan="2" style="background: #696969; color: #FFFFFF; text-align: center;" |Blood culture
-| style="background: #696969; color: #FFFFFF; text-align: center;" |+
+| style="background: #696969; color: #FFFFFF; text-align: center;" | +
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |20%
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |
 |}
-===== 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 [[Endocarditis diagnosis|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].
 ==References==
@@ Line 113: / Line 78: @@
 {{WH}}
 {{WS}}
+[[Category:Medicine]]
+[[Category:Infectious disease]]
+[[Category:Nephrology]]
+[[Category:Urology]]
+[[Category:Up-To-Date]]
+[[Category:Emergency medicine]]