Acute Pyelonephritis

Transcription

1 Acute Pyelonephritis Variant 1: Acute pyelonephritis. Uncomplicated patient (eg, no history of diabetes or immune compromise or history of stones or obstruction or prior renal surgery or lack of response to therapy). Initial imaging. Procedure CT abdomen and pelvis with IV CT abdomen and pelvis without IV CT abdomen and pelvis without and with IV X-ray intravenous urography Appropriateness Category SOE RRL Panel Rating ( ) ( ) msv ( ) msv Group Median Rating Final Tabulations

2 Voiding cystourethrography MRI abdomen without IV O 0 msv O MRI abdomen without and with IV O 0 msv O IV O 0 msv O 0 and with IV O 0 msv O 0 Tc-99m DMSA scan kidney 1-10 msv X-ray abdomen and pelvis (KUB) X-ray antegrade pyelography 1-10 msv

3 US color Doppler kidneys and bladder retroperitoneal O 0 msv O Variant 2: Acute pyelonephritis. Complicated patient (eg, diabetes or immunocompromised or history of stones or prior renal surgery or not responding to therapy). Initial imaging. CT abdomen and pelvis with IV Usually ( ) 4 13 ( ) 4 14 ( ) 4 18 ( ) 4 19 ( ) 3 CT abdomen and pelvis without IV ( ) 2 11 ( ) 4 12 ( ) 4 13 ( ) 4 14 ( ) 4 15 ( ) 4 16 ( ) 4 17 ( ) 3 CT abdomen and pelvis without and with IV Usually msv

4 X-ray intravenous urography Voiding cystourethrography MRI abdomen without IV MRI abdomen without and with IV IV and with IV 8 ( ) 4 20 ( ) msv ( ) 4 9 ( ) 2 10 ( ) O 0 msv O O 0 msv O O 0 msv O ( ) 4 18 ( ) 4 19 ( ) 3 O 0 msv O

5 18 ( ) 4 27 ( ) 3 28 ( ) 3 29 ( ) 4 30 ( ) 2 Tc-99m DMSA scan kidney 1-10 msv ( ) 4 27 ( ) 3 28 ( ) 3 29 ( ) 4 36 ( ) 3 37 ( ) 1 38 ( ) 1 39 ( ) 4 X-ray abdomen and pelvis (KUB) X-ray antegrade pyelography 1-10 msv US color Doppler kidneys and bladder retroperitoneal O 0 msv O

6 Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below. Final Tabulations: A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, etc.) Disagree: The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation. : Lists the references associated with the recommendation. SQ: (1, 2, 3, 4, Good M or Inadequate M) of the references listed. RRL: Information on the Relative Radiation Level (RRL) designations can be found.