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Clinical Value of Acute Pyelonephritis Grade Based on Computed Tomography in Predicting Severity and Course of Acute Pyelonephritis

Paick, Sung Hyun MD, PhD*; Choo, Gwoan Youb MD; Baek, Minki MD; Bae, Sang Rak MD*; Kim, Hyeong Gon MD, PhD*; Lho, Yong Soo MD, PhD*; Jung, Sung Il MD, PhD§; Park, Hyoung Keun MD, PhD*

Journal of Computer Assisted Tomography: May/June 2013 - Volume 37 - Issue 3 - p 440–442
doi: 10.1097/RCT.0b013e318287365e
Cardiovascular Imaging

Purpose: This study aimed to evaluate the efficacy of computed tomography (CT)–based acute pyelonephritis (APN) grades for predicting clinical severity and disease course.

Materials and Methods: This study involved the analysis of the data of 204 consecutive patients with APN who underwent a CT examination at admission. Patients who had undergone prior treatment and those with ureteral calculi or an abscess by CT were excluded. Computed tomographic findings were divided into 4 grades according to renal parenchymal involvement, as follows: no renal parenchyma involvement (grade 1), less than 25% involvement (grade 2), 25% to 50% involvement (grade 3), and greater than 50% (grade 4). Patients with these grades were compared with respect to APN severity index (highest body temperature, initial C-reactive protein, and leukocytosis) and recovery index (hospital stay, fever duration, and leukocytosis duration).

Results: A total of 204 patients of mean age 39.3 years were included. Acute pyelonephritis severity indices and recovery indices increased with APN grade. Mean highest body temperature values were 38.3°C and 38.9°C in grades 1 and 4, respectively (P = 0.002). Mean hospital stay increased from 5.7 days for grade 1 to 7.6 days for grade 4 (P < 0.001). Initial C-reactive protein, initial leukocytosis, fever duration, and leukocytosis duration also increased with APN grade.

Conclusions: This study suggests that APN grades, as determined by CT examination, valuably predict the clinical course of APN.

From the *Department of Urology, School of Medicine, Konkuk University; †Department of Urology, College of Medicine, Inha University, Incheon; ‡Department of Urology, Sungkyunkwan University School of Medicine, Samsung Medical Center; and §Department of Radiology, School of Medicine, Konkuk University, Seoul, South Korea,

Received for publication October 24, 2012; accepted January 10, 2013.

Reprints: Hyoung Keun Park, MD, PhD, Department of Urology, School of Medicine, Konkuk University (e-mail:

This study was supported by Konkuk University in 2012.

The authors have no conflicts of interest to report.

© 2013 by Lippincott Williams & Wilkins