title: [What if it is not an acute pyelonephritis? A monocentric experience of renal infarcts].
abstract: BACKGROUND
  Often the reduced contrast enhancement on CT renal imaging is radiologically interpreted as acute pyelonephritis (PNA), but it is the task of the clinician to assess a possible differential diagnosis such as a renal infarct and look for a cause.
  
  
  METHODS
  In our experience (2010-2013), we hospitalized 51 patients with radiological imaging consistent with acute pyelonephritis in native kidneys. However, three of these cases result, after a second look, to be ischemic lesions, only sometimes complicated by over-infections (Tabella 1).
  
  
  RESULTS
  
  
  
  METHODS
  a woman hospitalized for fever and flank pain with blood culture positive for Klebsiella Pneumoniae. Antibiotic therapy allowed a clinical-laboratory improvement, but after 45 days persisted a focal wedge to the CT scan. The labs showed a anemia due to a sickle cell disease (SLC). The overview was finally interpreted as a renal infarct secondary to a sickle cell anemia, initially complicated by over-infection.
  
  
  METHODS
  a men hospitalized for a acute flank pain. The CT scan showed a left renal infarct and a partial renal artery thrombosis, resulting in abuse of cannabinoids and LAC positivity.Third case: a woman hospitalized for flank pain and slight movement of inflammatory markers. CT showed a cuneiform area in the right kidney not vascularized, that did not resolved after prolonged antibiotic therapy. The labs evidence a heterozygous mutation of prothrombin and MTHFR causing the renal infarction.
  
  
  CONCLUSIONS
  6% of radiographic imaging consistent with acute pyelonephritis concealed an underlying infarct, due to a unknown state of thrombophilia. The presence of hypovascular imaging to the TC scan, therefore, requires a differential diagnosis between PNA and infarct, especially in the case of atypical development.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Radin
authors.forename: Cristina
authors.initials: C
authors.lastname: Izzo
authors.forename: Marco
authors.initials: M
authors.lastname: Quaglia
authors.forename: Guido
authors.initials: G
authors.lastname: Merlotti
authors.forename: Angelo
authors.initials: A
authors.lastname: Nappo
authors.forename: Michele
authors.initials: M
authors.lastname: Battista
authors.forename: Gabriele
authors.initials: G
authors.lastname: Guglielmetti
authors.forename: Piero
authors.initials: P
authors.lastname: Stratta
mesh_terms: D000208:Acute Disease; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging*; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011704:Pyelonephritis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed