[The use of renal ultrasound for adult acute pyelonephritis]. / Uso de la ecografía en la pielonefritis aguda del adulto.

OBJECTIVES: To evaluate the need to perform renal ultrasound (US) in adult patients with acute pyelonephritis (APN). METHODS: A Review of the bibliography in the data bases PubMed and Cochrane Collaboration about the use of the ultrasonography in the evaluation and diagnosis of APN. RESULTS: Thirty-seven papers were found, but only 5 fulfilled the requirements for analysis. Four hundred and sixty three patients diagnosed of APN were revised, 449 (977) of whom got US. Between 171 ultrasonographic findings, only in 52 (11.5%) cases US findings changed initial diagnosis to complicated APN that could lead to surgery. CONCLUSION: The low incidence of ultrasonographic findings does not justify the practice of renal US to every patient with APN. In patients with persistent fever longer than 72 hours, antecedents of anomalies of the urinary tract, antecedents of renal lithiasis, pregnancy, atypical clinic or diabetes mellitus, there is a higher incidence of pathological US findings that justify a change in the therapeutic approach. Further prospective clinical studies are needed to confirm these conclusions.

Uso de la ecografía en la pielonefritis aguda del adulto / The use of renal ultrasound for adult acute pyelonephritis

Objetivo: Evaluar la necesidad de la realización de una ecografía en los pacientes adultos afectos de una pielonefritis aguda (PNA). Métodos: Revisión de la bibliografía existente en las bases de datos PubMed y Cochrane Collaborattion sobre el uso de la ecografía para valoración y diagnóstico de PNA. Resultados: Se encontraron 37 textos de los cuales únicamente cumplían requisitos para su análisis 5. En total se analizaron 463 pacientes de los cuales a 449 (97%) se le realizó una ecografía por el diagnóstico de PNA. De los 171 hallazgos ecográficos, únicamente en 52 (11.5%) cambiaba el diagnóstico a PNA complicada con posibilidad de tratamiento quirúrgico. Conclusion: La baja incidencia de hallazgos ecográficos no justifica su realización a todo paciente con PNA. En los pacientes con fiebre persistente más de 72 horas (h), antecedentes de anomalías de la vía urinaria, antecedentes de litiasis renal, gestación, clínica atípica o diabetes mellitus, existe una mayor incidencia de hallazgos patológicos en la ecografía que justifiquen un cambio de actitud terapéutica. Hacen falta estudios bien diseñados para confirmar estas conclusiones (AU)

Objectives: To evaluate the need to perform renal ultrasound (US) in adult patients with acute pyelonephritis (APN). Methods: A Review of the bibliography in the data bases PubMed and Cochrane Collaboration about the use of the ultrasonography in the evaluation and diagnosis of APN. Results: Thirty-seven papers were found, but only 5 fulfilled the requirements for analysis. Four hundred and sixty three patients diagnosed of APN were revised, 449 (97%) of whom got US. Between 171 ultrasonographic findings, only in 52 (11.5%) cases US findings changed initial diagnosis to complicated APN that could lead to surgery. Conclusion: The low incidence of ultrasonographic findings does not justify the practice of renal US to every patient with APN. In patients with persistent fever longer than 72 hours, antecedents of anomalies of the urinary tract, antecedents of renal lithiasis, pregnancy, atypical clinic or diabetes mellitus, there is a higher incidence of pathological US findings that justify a change in the therapeutic approach. Further prospective clinical studies are needed to confirm these conclusions (AU)