genitourinary disorders
Chronic Pyelonephritis
Diagnosis of Chronic Pyelonephritis
Urinalysis and urine culture Imaging Chronic pyelonephritis is suspected in patients with a history of recurrent urinary tract infections (UTIs) and Acute pyelonephritis . However, most patients, except for children with vesicoureteral reflux (VUR), do not have such a history. Sometimes the diagnosis is suspected because typical findings are incidentally noted on an imaging study. Symptoms, because they are vague and nonspecific, may not suggest the diagnosis. Urinalysis and urine culture and usually imaging tests are done. Urinary sediment is usually scant, but renal epithelial cells, granular casts, and occasionally white blood cell (WBC) casts are present. Proteinuria is almost always present and can be in the nephrotic range if VUR causes extensive renal damage. When both kidneys are involved, defects in concentrating ability and hyperchloremic acidosis may appear before significant azotemia occurs. Urine culture may be sterile or positive, usually for gram-negative organisms. Initial imaging is usually with ultrasonography, helical CT, or intravenous urography (IVU). The hallmark of chronic pyelonephritis (usually with reflux or obstruction) on imaging is classically a large, deep, segmental, coarse cortical scar usually extending to one or more of the renal calyces. The upper pole is the most common site. Renal cortex is lost, and the renal parenchyma thins. Uninvolved renal tissue may hypertrophy locally with segmental enlargement. Ureteral dilation may be present, reflecting the changes induced by chronic severe reflux. Similar changes can occur with urinary tract Genitourinary tuberculosis . . CT imaging is done to detect Urinary Calculi or other obstruction. Imaging shows an avascular mass with a variable degree of extension around the kidney. Sometimes, to differentiate cancer (eg, 