Acute pyelonephritis and renal abscesses in adults--correlating clinical parameters with radiological (computer tomography) severity.

INTRODUCTION: The aim of this study is to evaluate the correlations between clinical and biochemical parameters with radiological severity of CT diagnosed acute pyelonephritis (APN) and renal abscesses, thereafter defining clinical predictors to identify patients with severe APN or renal abscesses.
MATERIALS AND METHODS: The inpatient medical records of all patients diagnosed with APN or renal abscesses admitted over one year were reviewed. Patients with CT imaging performed were classified into 3 groups--mild APN, severe APN and renal abscesses. Clinical and biochemical parameters were correlated with radiological severity.
RESULTS: One hundred and thirty patients were included in the study. Male gender, older age, presence of diabetes mellitus and unobstructing renal stones were significantly associated with severe APN or renal abscesses. Clinical and biochemical parameters that were associated with more severe disease include a higher leucocyte count and C-reactive proteins, left neutrophil shift, thrombocytosis or thrombocytopenia, low serum albumin, acute renal impairment and bacteremia. The percentage of patients had positive urine and blood cultures were 40.8% and 30.7% respectively. Of these patients, 97.9% had severe APN or renal abscesses on CT imaging had diabetes mellitus (DM), hypotension, acute renal failure or leucocyte count of >20K.
CONCLUSION: Our study showed a good correlation between clinical and radiological severity in adult patients with APN and renal abscesses. Patients with severe APN or renal abscesses were likely to be diabetics presenting with hypotension, acute renal impairment and a leucocyte count of greater than 20K.