Imaging

Renal ultrasound is another tool increasingly used in the ED. It is a valuable diagnostic tool in assessing loin pain. It may reveal complications of urinary tract infection such as hydronephrosis and renal abscess. It is useful in many clinical situations including renal calculi complicated by infection, patients with UTI associated with severe sepsis and where surgical intervention may be required for a complication of UTI, for example, obstruction and abscess.

Routine imaging is not required in most young women with uncomplicated infections and has an extremely low yield for detecting abnormalities. In the past, recommendations have been made to ultrasound all cases of pyelonephritis, but are probably best reserved where there is clinical suspicion of complications. Severely unwell patients, those who fail to resolve and those in whom diagnostic uncertainty exists, require urgent imaging.

CT will detect any renal calculi, hydronephrosis and abscess, yet is most usually saved for renal colic or diagnostic uncertainty.

Learning bite

Uncomplicated pyelonephritis in a well patient can usually be managed as an out-patient initially.