Pyelonephritis diagnostic study of choice: Difference between revisions

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Line 25: Line 25:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! rowspan="7" |Urinalysis
! rowspan="7" style="background: #696969; color: #FFFFFF; text-align: center;" |Urinalysis
! rowspan="2" |WBC
! 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
| colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |> 5 WBCs/HPF
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |72-95%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |72-95%
Line 35: Line 35:
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |65-86%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |65-86%
|-
|-
!RBC
! style="background: #696969; color: #FFFFFF; text-align: center;" |RBC
| colspan="1" rowspan="1" | +
| colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |+
| colspan="1" rowspan="1" |44%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |44%
| colspan="1" rowspan="1" |88%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |88%
|-
|-
| colspan="1" rowspan="1" |Leukocyte esterase test
! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Leukocyte esterase test
| colspan="1" rowspan="1" | +
| colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" | +
| colspan="1" rowspan="1" |74-96%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |74-96%
| colspan="1" rowspan="1" |94-98%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |94-98%
|-
|-
| colspan="1" rowspan="1" |Nitrite test
! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Nitrite test
| colspan="1" rowspan="1" | +
| colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" | +
| colspan="1" rowspan="1" |35-85%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |35-85%
| colspan="1" rowspan="1" |92-100%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |92-100%
|-
|-
| colspan="1" rowspan="1" |Combination leukocyte esterase and nitrite tests
! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Combination leukocyte esterase and nitrite tests
| colspan="1" rowspan="1" |Either test +
| colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Either test +
| colspan="1" rowspan="1" |75-84%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |75-84%
| colspan="1" rowspan="1" |82-98%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |82-98%
|-
|-
| colspan="1" rowspan="1" |Gram stain of uncentrifuged urine
! colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |Gram stain of uncentrifuged urine
| colspan="1" rowspan="1" |> 1 bacterium per HPF
| colspan="1" rowspan="1" style="background: #696969; color: #FFFFFF; text-align: center;" |> 1 bacterium per HPF
| colspan="1" rowspan="1" |93%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |93%
| colspan="1" rowspan="1" |95%
| colspan="1" rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |95%
|-
|-
! colspan="2" |Urine culture
! colspan="2" style="background: #696969; color: #FFFFFF; text-align: center;" |Urine culture
!+
| style="background: #696969; color: #FFFFFF; text-align: center;" |+
!90%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%
!
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|-
|-
! colspan="2" |Blood culture
! colspan="2" style="background: #696969; color: #FFFFFF; text-align: center;" |Blood culture
!+
| style="background: #696969; color: #FFFFFF; text-align: center;" |+
!20%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |20%
!
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
|}
|}



Revision as of 19:20, 12 June 2018

Urinary Tract Infections Main Page

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Diagnostic Study of choice

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

Overview

Diagnostic Study of Choice

Study of choice

  • There is no single diagnostic study of choice for 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.
  • 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 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]

Test Sensitivity Specificity
Urinalysis WBC > 5 WBCs/HPF 72-95% 48-82%
> 10 WBCs/HPF 58-82% 65-86%
RBC + 44% 88%
Leukocyte esterase test + 74-96% 94-98%
Nitrite test + 35-85% 92-100%
Combination leukocyte esterase and nitrite tests Either test + 75-84% 82-98%
Gram stain of uncentrifuged urine > 1 bacterium per HPF 93% 95%
Urine culture + 90%
Blood culture + 20%
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 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

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