ACR Appropriateness Criteria® Acute Pyelonephritis

Expert Panel on Urologic Imaging:

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)S232-S239
JournalJournal of the American College of Radiology
Volume15
Issue number11
DOIs
StatePublished - Nov 1 2018

Fingerprint

Pyelonephritis
Kidney
Abscess
Therapeutics
Infection
Guidelines
Vesico-Ureteral Reflux
Kidney Pelvis
Expert Testimony
Immunocompromised Host
Cross Infection
Urinary Tract
Radiology
Urinary Tract Infections
Causality
Anti-Bacterial Agents
Recurrence
Pregnancy
Population

Keywords

  • Appropriate Use Criteria
  • Appropriateness Criteria
  • AUC
  • CT
  • Diagnostic imaging
  • MRI
  • Pyelonephritis
  • Renal infection
  • Renal parenchyma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

ACR Appropriateness Criteria® Acute Pyelonephritis. / Expert Panel on Urologic Imaging:.

In: Journal of the American College of Radiology, Vol. 15, No. 11, 01.11.2018, p. S232-S239.

Research output: Contribution to journalArticle

Expert Panel on Urologic Imaging:. / ACR Appropriateness Criteria® Acute Pyelonephritis. In: Journal of the American College of Radiology. 2018 ; Vol. 15, No. 11. pp. S232-S239.
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abstract = "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.",
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