What is the role of ultrasonography (US) in the evaluation of acute pyelonephritis (kidney infection)?

Updated: Jul 01, 2021
  • Author: Tibor Fulop, MD, PhD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Ultrasonography (US) can sometimes detect acute pyelonephritis, but a negative study does not exclude the possibility. Power Doppler US is superior to color Doppler US in the detection of pyelonephritis but remains inferior to contrast-enhanced helical/spiral computed tomography (CECT).

Kidney US is nevertheless a useful imaging modality in patients with complicated UTIs, and it may be performed at the bedside in a patient who is hemodynamically unstable. It is relatively inexpensive and does not involve radiation or iodinated contrast. It is an alternative to CT to identify hydronephrosis if there is concern regarding nephrolithiasis. [16] US is useful in screening for urinary obstruction in children admitted for febrile illnesses.

In a study of 207 patients with acute pyelonephritis, Enikeev et al reported that the main findings on US were the following [20] :

  • Decreased mobility of the kidney
  • Enlargement of the kidney
  • Thickened parenchyma
  • Hydrophilic parenchyma
  • Impairment of corticomedullary differentiation

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