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PubMed1979

[The pathogenesis of chronic pyelonephritis and its therapeutic consequences].

During the last 2 years we examined 186 patients with secondary and 42 patients with primary chronic pyelonephritis. In most cases the secondary pyelonephritis is the sequel of a urolithiasis, less frequently in congenital renal anomalies, adenomas of the prostatic gland and patients with superposed pyelonephritis in renal lesion on account of metabolic disturbances (diabetes, gout) or abuse of analgetics. The course of the disease as well as the results of the therapy show peculiarities in the two forms of pyelonephritis. Thus, for example, the recidivations are more frequently in the secondary pyelonephritis, in the urine culture other germs appear more frequently, and the disease shows a more rapid course. The bacterial sanation in patients with primary pyelonephritis remains stable in the course of one year, where as in the obstructive pyelonephritis (non-operated cases) in the same period all patients show recidivations. After operative treatment of the obstruction the conservative treatment leads to a bacterial sanation in about 70%. In patients with superposed pyelonephritis at first the basic disease is to be treated, i.e. the metabolic disturbances are to be compensated and at the same time an antibacterial therapy is to be performed.

Adult↗
PubMed1993

[Clinical description of acute pyelonephritis].

Acute pyelonephritis is frequent. Its usual signs and symptoms comprise renal pain, fever, inflammation, and presence of germs and leukocytes in the urine. Primary acute E. coli pyelonephritis is frequent in the young female and in most cases is a benign condition. Atypical pyelonephritis may be painless, or without high fever, or lacking bacterial growth in the urine owing to previous inappropriate treatment. Severe pyelonephritis is mainly observed in diabetic, alcoholic or immunocompromised patients. In occasional cases, a common form of pyelonephritis may develop to formation of a renal abscess requiring drainage. When secondary to urinary tract abnormalities, pyelonephritis may be complicated with septicaemia and can induce early and severe renal tissue damage. This form warrants early urological treatment. The common pyelonephritis of the young female without previous history of febrile urinary tract infection requires little imaging. Conversely, extensive uroradiological workup is mandatory in the very young and the elderly, in the male, when treatment is not rapidly effective or in case or early relapse. In some cases, pyelonephritis leads to the development of cortical scars, the long-term prognosis of which remains to be determined.

Abscess↗
PubMed1997

Surgical management of grades III and IV primary vesicoureteral reflux in children with and without acute pyelonephritis as breakthrough infections: a comparative analysis.

PURPOSE: Although high grade vesicoureteral reflux associated with breakthrough infection may be an indication for surgical intervention, it remains uncertain whether acute pyelonephritis as breakthrough infection is a risk for renal scar formation and whether surgery performed without it has any advantage. We assessed the results of antireflux surgery for high grade vesicoureteral reflux in children with and without acute pyelonephritis as breakthrough infections. MATERIALS AND METHODS: A total of 33 boys and 27 girls (102 refluxing units) less than 3 years old with grades III and IV vesicoureteral reflux who underwent surgical management because of breakthrough infections were retrospectively studied in a 3-year period. Of the 60 patients 30 (group 1) presented with breakthrough infections of acute pyelonephritis, although they were maintained on prophylactic antibacterials. The remaining 30 patients (group 2) underwent surgery without acute pyelonephritis as the breakthrough infections. There was no renal scar formation at the diagnosis of vesicoureteral reflux in either group. Patients with renal scars were excluded from study. There was no significant difference in patient gender (p = 0.795) or distribution of bilateral vesicoureteral reflux (p = 0.781) in the groups. Group 1 patients were significantly younger at the diagnosis of vesicoureteral reflux (p = 0.006). RESULTS: Although 55 patients presented with a febrile urinary tract infection at the diagnosis of vesicoureteral reflux, the infection was not significantly related to the development of renal scars (p = 0.066). Of the 55 patients 12 presented with acute pyelonephritis as the initial episode of urinary tract infection. The presence of acute pyelonephritis at the diagnosis of vesicoureteral reflux was also not significantly related to renal scar formation (p = 0.207). Postoperative urinary tract infections developed in 34 patients but there was no significant correlation between postoperative urinary tract infections and renal scar formation (p = 0.235). At followup 17 group 1 and 7 group 2 patients (29 renal units) were found to have renal scars. CONCLUSIONS: Renal scars were significantly more common in younger children with than without acute pyelonephritis as breakthrough infections (p = 0.010). Although breakthrough infections in high grade reflux may be an indication for antireflux surgery, the most appropriate results were achieved when acute pyelonephritis was not a breakthrough infection.

Acute Disease↗
PubMedDate not supplied

The characteristics and hospital course of patients admitted for presumed acute pyelonephritis.

To study the characteristics and hospital courses of patients hospitalized for presumed acute pyelonephritis, the authors analyzed 185 cases. Judged by explicit clinical and laboratory criteria, 54% of the patients definitely had pyelonephritis, 22% probably had pyelonephritis, 9% possibly had pyelonephritis, and 16% did not have pyelonephritis. In pretreatment urine cultures, 79% of patients had a single pathogen and 77% had colony counts of 100,000 or more organisms per ml. Non-Escherichia coli infections and positive blood cultures were the only two independent predictors of the concomitant renal stones or genitourinary tract abnormalities that were found in 29% of patients with pyelonephritis. About 15% of all patients continued to have temperatures greater than or equal to 101 degrees F 48 hours after the initiation of antibiotic therapy, but persistent fever did not correlate with a history of prior urinary tract infection, the presence of resistant pathogens, renal stones, or genitourinary tract abnormalities. The authors conclude that many of these patients did not have pyelonephritis, and that certain characteristics correlate with the presence of underlying anatomic abnormalities.

Acute Disease↗
PubMed2005

Urinary aquaporin-2 in children with acute pyelonephritis.

Children with acute pyelonephritis develop polyuria and have reduced maximum urinary concentration capacity. We studied whether these abnormalities are associated with altered urinary excretion of the water channel aquaporin-2 (AQP2) in the renal collecting duct. AQP2 is the main target for antidiuretic action of arginine vasopressin (AVP), and the urinary excretion of this protein is believed to be an index of AVP signaling activity in the kidney. Children with acute pyelonephritis, aged 5-14 years, were examined for urinary flow rate, creatinine clearance, unchallenged urine osmolality, and urinary ion excretion. Urinary excretion of AQP2 was measured by dot immunoblotting technique. Studies were performed in the acute phase of pyelonephritis, in the same children after treatment, and in control patients. At the onset of pyelonephritis, urinary flow rate and solute excretion were increased, but the urinary osmolality was unchanged. The urinary level and urinary excretion of AQP2 was increased in acute pyelonephritis and decreased after treatment. Excretion of aquaporin-3 was unchanged, suggesting that the increase in AQP2 urinary excretion was not due to a shedding of collecting duct cells. The results suggest that a mechanism proximal to the collecting duct may be responsible for the polyuria observed in children with acute pyelonephritis. Increased urinary AQP2 levels suggest that a compensatory activation of apical plasma membrane targeting of AQP2 may occur in pyelonephritis.

Acute Disease↗
PubMed2005

Increased concentration of the complement split product C5a in acute pyelonephritis during pregnancy.

OBJECTIVE: Pregnant women with acute pyelonephritis develop acute respiratory distress syndrome (ARDS) more frequently than non-pregnant women. The reasons for this remain unknown. The complement system is a complex set of self-assembling proteins that have been implicated in the pathophysiology of ARDS and sepsis. The purpose of this study was to determine if activation of the complement system occurs in pregnant women with acute pyelonephritis. METHODS: A cross-sectional study was conducted to determine the plasma concentrations of C3a, C4a and C5a (i.e., complement split products) in pregnant patients with acute pyelonephritis (n=38) and normal pregnant women (n=38). The complement split products C3a, C4a and C5a were measured using ELISA. Data were analyzed using non-parametric statistics. RESULTS: 1) The median plasma concentration of C5a in pregnant patients with acute pyelonephritis was significantly higher than that in normal pregnant women (p<0.001); 2) there was no statistical difference in the median plasma concentration of C3a and C4a between the two groups (p>0.05); and 3) concentrations of C3a, C4a and C5a were not different among patients with acute pyelonephritis with and without bacteremia. CONCLUSIONS: 1) Pyelonephritis in pregnant women is associated with an increased plasma concentration of C5a, but not C3a and C4a; and 2) an excess of C5a can predispose pregnant women to develop ARDS and multi-organ failure in pyelonephritis. This finding may have clinical implications since blocking C5a improves ARDS in experimental sepsis.

Acute Disease↗
PubMed1994

Renal scarring after acute pyelonephritis.

Seventy six children, 18 boys and 58 girls, aged 0-15.9 (median 1.0) years, with acute pyelonephritis were prospectively studied with a technetium-99m dimercaptosuccinic acid (DMSA) scan during infection and two months later. Fifty nine of these children were also studied two years after the infection. Seventeen children with a normal DMSA scan during infection or at two months after infection, or both, were not investigated by a DMSA scan at two years after acute pyelonephritis. A micturition cystourethrogram was performed in all the children after two months. Changes on the DMSA scan were found in 65 (86%) children during acute pyelonephritis, in 45 (59%) children at two months, and in 28 (37%) children at two years after infection. Vesicoureteric reflux (VUR) was found in 19 (25%) children at two months. Renal scarring was significantly correlated with the presence of gross VUR and recurrent pyelonephritis, but 62% of the scarred kidneys were drained by non-refluxing ureters. Children with scars were older at the time of acute pyelonephritis than those without scars but no difference was found between the groups with regard to duration of illness, levels of C reactive protein and maximum white cell count, glomerular filtration rate, nor renal concentration capacity at the time of infection. It is concluded that renal scarring after acute pyelonephritis in children is more common than has been previously thought. Although children with gross VUR and recurrent pyelonephritis are at the greatest risk, renal scarring is more often seen without these risk factors.

Acute Disease↗
PubMed1999

Relevance in the emergency department of a decisional algorithm for outpatient care of women with acute pyelonephritis.

The outcome of three types of management for patients with acute pyelonephritis, in an emergency department is assessed. This was carried out by a prospective enrolment of patients with acute pyelonephritis. Through a decisional algorithm, doctors were encouraged to discharge female patients under 60 years with acute uncomplicated pyelonephritis, either directly from the emergency ward or after a short stay in the observation unit. All received a single intravenous dose of pefloxacin, after urine and blood cultures were obtained; before discharge a normal ultrasonography of the abdomen and the pelvis was required. Conversely, hospitalization was advised for patients who did not fit the criteria of uncomplicated pyelonephritis. Only females with positive urine cultures qualified. Of 83 patients enrolled, 70 were females with positive urine cultures, 60 of whom had uncomplicated pyelonephritis. At 3 weeks, two of 70 patients were lost to follow-up. In the remaining 68, favourable outcome was observed in 98% of 48 patients discharged from the observation unit (95% CI: [94%; 100%]), 90% of 10 discharged from the emergency ward (95% CI: [73%; 100%]) and 70% of 10 hospitalized (95% CI: [50%; 93%]). A decisional algorithm was useful in determining that over 85% of women who present to our emergency department with pyelonephritis have an uncomplicated form and may be safely treated as outpatients, if necessary after a brief stay in the observation unit. Prospective controlled trials are needed to determine duration of antimicrobial therapy, length of follow-up and finally, to compare tolerance and cost-effectiveness of outpatient vs. inpatient care of acute uncomplicated pyelonephritis.

Acute Disease↗
PubMed1989

[Chronic pyelonephritis in polycystic kidney].

The characteristics of chronic pyelonephritis are studied in 37 patients out of a total of 53 patients with proved renal polycystosis. A group of 71 patients with chronic pyelonephritis selected at random are used as a control group. The frequency of chronic pyelonephritis among the patients with renal polycystosis is 69.8%. The difference between the mean age of the patients with renal polycystosis and chronic pyelonephritis and the patients with renal polycystosis without chronic pyelonephritis is 8.6 years. A significant difference is established between these two groups of patients concerning the frequency of symptomatic hypertension--89.2% for the patients with renal polycystosis and chronic pyelonephritis and 45% for the patients with uncomplicated renal polycystosis. A similar difference is established also for the renal failure--respectively 64.9% and 37.5%. The frequency of hypertension and chronic renal failure is lower in the control group of patients. 59% of the patients with renal polycystosis and chronic pyelonephritis have significant bacteriuria, E. coli and Proteus being the most frequently isolated bacteria but Pseudomonas shows the highest drug resistance. The isolated bacteria are most sensitive to nitroxoline and aminoglycoside antibiotics.

Adolescent↗
PubMedDate not supplied

[Fibronectin and its significance in pyelonephritis].

Fibronectin levels were measured by enzyme immunoassay in 68 patients with pyelonephritis and 10 patients with chronic cystitis. The patients with chronic cystitis, acute and chronic non-obstructive pyelonephritis exhibited significantly high average blood fibronectin levels, whereas those with chronic obstructive pyelonephritis displayed the levels slightly different from those observed in healthy individuals. Hypofibronectinemia was detected in 23.3% of patients with chronic pyelonephritis. Preincubation of the neutrophils isolated from pyelonephritis patients with fibronectin increased the initially low phagocytic capacity without enhancing their metabolic activity. In experimental pyelonephritis, administration of exogenous fibronectin was demonstrated to contribute to a rapid bacterial elimination from the kidneys, to decrease the intensity of an inflammatory response, to prevent renal histostructural lesions, to enhance the functional activity of immunocompetent cells and to stabilize their membranes. The findings may serve the basis for using fibronectin in clinical practice as a promising agent to treat pyelonephritis.

Acute Disease↗
PubMed1977

[Tubular kidney dysfunction and its etiology in chronic pyelonephritis].

1. The renal dysfunction in the chronic compensated pyelonephritis means a selective decrease of the maximum osmotic concentration power, the ammonia secretion and the total secretion of hydrogen ions in the glomerular filtration rate, proximal reabsorption of the fluid of the tubule, excretion of osmotically free water and acidity of the urine which can be titrated. 2. The functional distrubances observed in chronic pyelonephritis do not as a whole differ from those disturbances in chronic compensated glomerulonephritis, but in the disease first mentioned there is in every case no decrease of the endogenic creatinine clearance and the maximum water diuresis. 3. The latent chronic pyelonephritis differs from the latent chronic glomerulonephritis by a normal endogenic creatinine clearance and maximum water diuresis and by a decrease of the ammonia and hydrogen ion secretion. These disturbances to a certain extent may be regarded as specific for the chronic pyelonephritis. In comparison with the chronic hypertonic pyelonephritis in the chronic hypertonic pyelonephritis the maximum water diuresis is normal and the titratable acidity is slightly increased. 4. The kind of renal dysfunctions can be of importance for the differential diagnosis between chronic glomerulonephritis and chronic pyelonephritis particularly in the latent forms of the two diseases.

Chronic Disease↗
PubMed2003

Antibiotics for acute pyelonephritis in children.

BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent renal damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by oral therapy for 7-14 days though there is no consensus on the duration of either IV or oral therapy. OBJECTIVES: To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children. SEARCH STRATEGY: We searched the Cochrane Register of Controlled Trials (Cochrane Library Issue 3, 2002), MEDLINE (1966 - September 2002), EMBASE (1988 -September 2002), reference lists of articles and abstracts from conference proceedings without language restriction. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0-18 years with proven UTI and acute pyelonephritis were selected. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weight mean difference (WMD) for continuous data with 95% confidence intervals (CI). MAIN RESULTS: Sixteen trials involving 1872 children were eligible for inclusion. No significant differences were found in persistent renal damage at six months (one trial, 306 infants: RR 1.45, 95% CI 0.69 to 3.03) or in duration of fever (WMD 0.80, 95% CI -4.41 to - 6.01) between oral cefixime therapy (14 days) and IV therapy (three days) followed by oral therapy (10 days). Similarly no significant differences in persistent renal damage (three trials, 315 children: RR 0.99, 95% CI 0.72 to 1.37) were found between IV therapy (3-4 days) followed by oral therapy and IV therapy for 7-14 days. In addition no significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (one trial, 179 children, persistent symptoms at three days: RR 1.98, 95% CI 0.37 to 10.53). REVIEWER'S CONCLUSIONS: These results suggest that children with acute pyelonephritis can be treated effectively with oral cefixime or with short courses (2-4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Trials are required to determine the optimal total duration of therapy and if other oral antibiotics can be used in the initial treatment of acute pyelonephritis.

Adolescent↗
PubMed2005

Antibiotics for acute pyelonephritis in children.

BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent renal damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by oral therapy for seven to 14 days though there is no consensus on the duration of either IV or oral therapy. OBJECTIVES: To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists of articles and abstracts from conference proceedings without language restriction. Date of most recent search: June 2004. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0 to 18 years with proven UTI and acute pyelonephritis were selected. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weight mean difference (WMD) for continuous data with 95% confidence intervals (CI). MAIN RESULTS: Eighteen trials (2612 children) were eligible for inclusion. No significant differences were found in persistent renal damage at six months (one trial, 306 infants: RR 1.45, 95% CI 0.69 to 3.03) or in duration of fever (WMD 0.80, 95% CI -4.41 to - 6.01) between oral cefixime therapy (14 days) and IV therapy (three days) followed by oral therapy (10 days). Similarly no significant differences in persistent renal damage (three trials, 315 children: RR 0.99, 95% CI 0.72 to 1.37) were found between IV therapy (3-4 days) followed by oral therapy and IV therapy for 7-14 days. In addition no significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (one trial, 179 children, persistent symptoms at three days: RR 1.98, 95% CI 0.37 to 10.53). AUTHORS' CONCLUSIONS: These results suggest that children with acute pyelonephritis can be treated effectively with oral cefixime or with short courses (2-4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Trials are required to determine the optimal total duration of therapy and if other oral antibiotics can be used in the initial treatment of acute pyelonephritis.

Acute Disease↗
PubMed1980

[Transplant pyelonephritis (author's transl)].

Examinations of the urine in 216 kidney allograft recipients resulted in significant bacteriuria in 274 samples of 1,802 urines tested. Bacteruria was found in 30 patients with recurrent or chronic persistent infections of the urinary tract; this patient group was studied by examination of 399 urine samples (mean 13.3 samples per patient). Four patients suffered from urologic complications after kidney grafting and were excluded from the study; 15 patients were diagnosed clinically and/or histologically with transplant pyelonephritis, 11 patients with cystitis. Of main importance for the diagnosis of transplant pyelonephritis were findings of persistent leucocyturia and the presence of antibody-coated bacteria. Both of these findings were repeatedly seen in all patients with transplant pyelonephritis. Clinical symptoms included fever and dysuria. In contrast to patients suffering from cystitis, transplant function detoriated in 13 of 15 patients with transplant pyelonephritis; two patients had to be treated by hemodialysis. Septicemia occurred in eight of the 15 patients studied. The data illustrate the frequency of transplant pyelonephritis as observed in 15 of 26 patients accompaining chronic urinary tract infection after kidney allograft transplantation. As a predisposing factor, obstruction of the urinary tract was diagnosed in eight of the 15 transplant recipients with pyelonephritis. The prednisone dose was higher than 10 mg in eight of 15 patients at the time transplant infection was diagnosed. Successful antibiotic treatment resulted in stable transplant function in three patients; four patients exhibited even lower serum creatinine levels after therapy.

Adult↗
PubMed2005

Proinflammatory cytokines and procalcitonin in children with acute pyelonephritis.

This prospective study, performed in 76 children with a urinary tract infection (UTI), evaluates the diagnostic value of procalcitonin (PCT) and proinflammatory cytokines (IL-1beta, IL-6 and TNF-alpha) in children with acute pyelonephritis documented by dimercaptosuccinic acid scintigraphy (DMSA). Renal parenchymal involvement was assessed by (99m )Tc-DMSA scintigraphy within 7 days of admission. The diagnosis of acute pyelonephritis was confirmed only in patients with reversible lesions on scintigraphy. According to DMSA scan results, patients were divided into two groups, lower UTI or acute pyelonephritis. In acute pyelonephritis, serum PCT level was found to be significantly higher than it is in the lower UTI (p <0.001). Also, significantly higher serum proinflammatory cytokines (IL-1beta, IL-6 and TNF-alpha) levels were detected in those with acute pyelonephritis than those with lower UTI (p <0.001). We conclude that both serum PCT and proinflammatory cytokine levels may be used as accurate markers for diagnosis of acute pyelonephritis.

Acute Disease↗
PubMed1991

Renal pelvicalyceal dilation in antepartum pyelonephritis: ultrasonographic findings.

The purpose of the present study was to determine whether pregnant women with pyelonephritis have differences of pelvicalyceal systems, compared with normal pregnant control subjects, that might predispose to upper urinary tract infection. Ultrasonographic examination of both kidneys in coronal and axial planes of 24 women with clinical pyelonephritis and positive urine cultures was compared with results in control subjects matched for gestational age, parity, and race. Women with right or bilateral pyelonephritis had increased dilation of the right calyceal system, compared with controls (1.7 cm vs 0.8 cm, p less than 0.001). Renal pelvis volume was increased as well (29.3 vs 5.5 cm3, p less than 0.001). Renal pelvicalyceal dilation in antepartum pyelonephritis was significantly increased compared with normal physiologic dilation of pregnancy. Follow-up nephrosonography in a small number of women (N = 10) after treatment of pyelonephritis did not reveal a consistent decrease in renal dilation, suggesting that dilation of the renal pelvis may antedate pyelonephritis. Further study of this phenomenon is warranted.

Dilatation, Pathologic↗
PubMed1991

Parenteral ofloxacin in treatment of pyelonephritis.

The interim findings of two studies of intravenous ofloxacin for the treatment of pyelonephritis are presented. The findings are from one center of a multicenter trial. In the first study intravenous (IV) ofloxacin was given to 34 patients with urine-culture-positive pyelonephritis. After three days of intravenous therapy patients could be switched to oral ofloxacin. Microbiologic eradication occurred in 97 percent and clinical cures in 97 percent of the patients treated with ofloxacin. There were three probable drug-related adverse events. In the second comparative study 38 patients with pyelonephritis were randomized to receive IV ofloxacin with the option of switching to oral ofloxacin after three days. IV ceftazidime was given to 30 patients with pyelonephritis with the option of switching to trimethoprim/sulfamethoxazole (TMP/SMX) after three days. Microbiologic cures were experienced by 97 percent of the ofloxacin patients and by 100 percent of the ceftazidime patients. Probable drug-related adverse reactions were experienced by 3/28 ofloxacin patients and by none of the ceftazidime patients. These interim study findings indicate that the intravenous preparation of ofloxacin is efficacious in the treatment of pyelonephritis and that it is safe. In addition, IV ofloxacin is as efficacious as IV ceftazidime for the treatment of pyelonephritis.

Administration, Oral↗
PubMed2006

A single procalcitonin level does not predict adverse outcomes of women with pyelonephritis.

OBJECTIVES: Predicting medical outcomes for pyelonephritis in women is difficult, leading to unnecessary hospitalization. Unlike other serious infectious diseases, high procalcitonin (PCT) level has never been associated with 28-d adverse medical outcomes in women with pyelonephritis. Therefore, we sought to determine the accuracy of PCT in discriminating between pyelonephritis with adverse medical outcome (PAMO) and pyelonephritis without adverse medical outcome (PWAMO). PATIENTS AND METHODS: Adult women with pyelonephritis presenting to the emergency department of a French tertiary care hospital were consecutively included. Those patients who developed adverse medical outcomes during a 28-d follow-up period were identified as having PAMO. Baseline characteristics and PCT level were compared between patients with PAMO and PWAMO. RESULTS: Eleven women (19.0%) had PAMO and 47 (81%) had PWAMO. The median PCT level was higher in PAMO compared with PWAMO 0.51 ng/ml (IQR: 0.04-3.8) and 0.08 ng/ml (IQR: 0.01-1.0), but this difference was not statistically significant (p=0.07). We failed to find a threshold value for PCT that discriminated between PAMO and PWAMO (ROC, AUC=0.67 [95%CI, 0.51-0.86]). All but one subject with PAMO had either a PCT level >0.1 ng/ml or an underlying genitourinary abnormality by radiographic testing. CONCLUSIONS: A single PCT level was a poor predictor of 28-d adverse medical outcomes in women with pyelonephritis treated in the emergency department. Prediction based on underlying genitourinary abnormality by radiographic testing in addition to the PCT level should be investigated in future studies.

Acute Disease↗