Acute bacterial nephritis: a clinicoradiologic correlation based on computed tomography.
OBJECTIVE
Acute bacterial nephritis (ABN) represents localized, nonliquefied renal infection, and the subsequent alteration of tissue densities can be readily detected by computed tomography (CT). In recent literature, a variety of renal parenchymal alterations observed on CT were reported. However, previous reports on the clinical course of ABN were inconsistent and lacked correlation with radiologic findings. In this investigation, we attempt to correlate the severity of clinical manifestations with CT findings in ABN and draw some conclusions regarding the natural history, pathophysiology, and clinical management of this disease.


METHODS
From July 1988 to June 1991, 30 cases of ABN were evaluated at our institute. On the basis of postcontrast-enhanced CT findings, 28 cases were grouped into (1) Group I (7 cases), wedge-shaped lesions (focal or diffuse); (2) Group II (12 cases), focal mass-like lesions; and (3) Group III (9 cases), diffuse (multifocal) mass-like lesions. The clinical features and outcomes of the three groups were compared. The positive detecting rates and clinical usefulness of ultrasonographic (US) and urographic examinations were also studied in each group.


RESULTS
An excellent correlation can be demonstrated between the clinical parameters (including underlying diseases, maximum temperature and leukocyte count, duration of fever, flank pain, leukocytosis, and pyuria; the incidence of septic shock, diabetic ketoacidosis, and acute renal failure; and outcome) and the pattern of renal parenchymal abnormalities detected on CT. The clinical features in Group I patients displayed many similarities with those in uncomplicated acute pyelonephritis (APN) reported previously, and responded to antibiotic therapy promptly. Most patients in Group II were successfully treated with antibiotics but had a protracted clinical course with a slower clinical improvement than Group I. Only one case with a Group II lesion was noted to progress to renal abscess formation and extrarenal involvement. In comparison, 33% of the patients in Group III died despite antibiotic therapy. Our data also show that US examination is sensitive in detecting Group II ABN lesions (62% positive rate), and revealed marked renal enlargement in most Group III lesions (89%). It is therefore a useful initial imaging modality in providing information vital to clinical decision making.


CONCLUSIONS
Our experiences suggest that renal bacterial infection may show the continuum of severity from uncomplicated APN to ABN, demonstrated on postcontrast CT scan as wedge-shaped lesions to mass-like lesions, and possibly, finally to frank abscess formation. We classify ABN into three subgroups according to CT findings, and good correlation with clinical severity is demonstrated. These findings deliver valuable concepts regarding the pathophysiology and clinical management of this disease.
Huang
J J
JJ
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China.
Sung
J M
JM
Chen
K W
KW
Ruaan
M K
MK
Shu
G H
GH
Chuang
Y C
YC
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D009393:Nephritis / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000503:physiopathology*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed