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40 year old female with left flank pain, fever, leukocytosis

Pyelonephritis

Bacterial infection of the kidney and urinary tract

Typical causes: E. Coil, Proteus, Klebsiella

• Define underlying pathology (obstruction, reflux, calculus)

• Rule out complications (abscess, emphysematous pyelonephritis, determine presence of chronic changes such as scarring)

Common underlying conditions: Diabetes, Immunosuppresion, Obstruction

Radiographic Features: most studies (IVP, CT, US) are normal (75%). Other 25% have non specific findings:

• Renal enlargement (edema)

• Loss of corticomedullary differentiation (edema)

• Areas of decreased perfusion by CECT

• Focal areas of hypodensity

• IVP findings: delay of contrast extretion, narrowing of collecting system (edema), striated nephrogram, ridging of uroepithelium

• Complications: abscess, scarring

Further examples