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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.

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.