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    IKD 2 - Imaging Renal Infection

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    Renal Association Mauritius
    This document discusses various types of renal infections that can be imaged, including pyelonephritis, renal abscesses, emphysematous pyelonephritis, and xanthogranulomatous pyelonephritis. CT is often the preferred imaging method but ultrasound and MRI are also used. Emphysematous pyelonephritis is a severe necrotizing infection seen in diabetics that appears as gas in the renal parenchyma. Xanthogranulomatous pyelonephritis is a chronic destructive process associated with long-term infection and obstruction that has a "bear paw" signature on CT. Tuberculosis can also infect the kidneys and manifest in

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    IKD 2 - Imaging Renal Infection

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    Renal Association Mauritius
    392 views49 pages
    This document discusses various types of renal infections that can be imaged, including pyelonephritis, renal abscesses, emphysematous pyelonephritis, and xanthogranulomatous pyelonephritis. CT is often the preferred imaging method but ultrasound and MRI are also used. Emphysematous pyelonephritis is a severe necrotizing infection seen in diabetics that appears as gas in the renal parenchyma. Xanthogranulomatous pyelonephritis is a chronic destructive process associated with long-term infection and obstruction that has a "bear paw" signature on CT. Tuberculosis can also infect the kidneys and manifest in

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    Imaging Renal Infection by Dr A Veeraterapillay

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    This document discusses various types of renal infections that can be imaged, including pyelonephritis, renal abscesses, emphysematous pyelonephritis, and xanthogranulomatous pyelonephritis. CT is often the preferred imaging method but ultrasound and MRI are also used. Emphysematous pyelonephritis is a severe necrotizing infection seen in diabetics that appears as gas in the renal parenchyma. Xanthogranulomatous pyelonephritis is a chronic destructive process associated with long-term infection and obstruction that has a "bear paw" signature on CT. Tuberculosis can also infect the kidneys and manifest in

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    392 views49 pages

    IKD 2 - Imaging Renal Infection

    Uploaded by

    Renal Association Mauritius
    This document discusses various types of renal infections that can be imaged, including pyelonephritis, renal abscesses, emphysematous pyelonephritis, and xanthogranulomatous pyelonephritis. CT is often the preferred imaging method but ultrasound and MRI are also used. Emphysematous pyelonephritis is a severe necrotizing infection seen in diabetics that appears as gas in the renal parenchyma. Xanthogranulomatous pyelonephritis is a chronic destructive process associated with long-term infection and obstruction that has a "bear paw" signature on CT. Tuberculosis can also infect the kidneys and manifest in

    Copyright:

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    of 49

    IMAGING RENAL INFECTION

    Dr Aditi Veeratterapillay
    Consultant Radiologist
    Overview
    • Pathogenesis of urinary tract infections

    • Pyelonephritis

    • Renal and perinephric abscess

    • Emphysematous pyelonephritis

    • Xanthogranulomatous pyelonephritis

    • TB
    Types of PYELONEPHRITIS
    • ACUTE UNCOMPLICATED

    • ACUTE COMPLICATED

    • CHRONIC

    • EMPHYSEMATOUS PYELONEPHRITIS

    • XANTHOGRANULOMATOUS PYELONEPHRITIS
    INDICATIONS FOR IMAGING
    • DIABETIC PATIENTS
    • IMMUNOCOMPROMISED PATIENTS
    • HISTORY OF UROLITHIASIS
    • KNOWN CASE OF RENAL ANOMALY
    • RECENT UROLOGICAL PROCEDURE
    • PERSISTENCE OF LEUKOCYTOSIS AND FEVER 72 HRS AFTER
    ANTIBIOTIC TREATMENT
    Options for Imaging
    • Computed tomography (CT) of the abdomen and pelvis with
    contrast is considered the study of choice. Detects focal
    parenchymal abnormalities, anatomic anomalies,
    emphysematous changes, cause of ureteric obstruction perinephric
    fluid collections and abscesses that necessitate a change in
    management

    • CT Urogram technique
    3 phases
    Non-contrast phase
    Nephrographic phase scanned at 80 to 120 s delay
    Excretory phase scanned at 10–15 min delay.
    Ultrasonography is most helpful in detecting hydronephrosis ,
    pyonephrosis and perinehric collection. Advantages are
    relatively low cost, easily available portability, and the lack of
    radiation and contrast exposure

    MRI
    • more costly
    • time-consuming compared to CT
    • MRI is nevertheless the imaging study of choice if
    iodinated contrast or ionizing radiation must be avoided
    and in pregnancy.
    Steinstrasse (German for
    'stone street'), refers to
    multiple small ureteric
    stones, seen aligned in
    the right ureter, that
    occur as a complication
    of ESWL.
    ULTRASOUND
    • ENLARGED KIDNEY
    • HYPOECHOIC
    • REDUCED FLOW TO THE AREA ON DOPPLER
    • HYDRONEPHROSIS
    • HYDROURETER - CALCULUS AT UVJ EASILY DETECTED
    • RENAL AND PERINEPHRIC ABSCESS – IMPORTANT ROLE OF
    RADIOLOGIST IN USG / CT GUIDED ASPIRATION
    CT Features of PYONEPHROSIS

    Dilatation and obstruction of the collecting system


    Thickening of renal pelvic wall > 2 mm.
    Higher than usual attenuation values of the fluid within the renal
    collecting system
    Gas-fluid levels in the intrarenal collecting system
    • Clinical features of acute infection along with hydronephrosis is the
    most sensitive indicator of pyonephrosis.
    Pyonephrosis
    • Presence of pus within the upper collecting system
    • Obstruction to the urinary tract common cause
    • USG shows debris in the collecting system or a fluid fluid level .
    Acute PYELONEPHRITIS CT
    AREA OF REDUCED ENHANCEMENT AND STRIATED NEPHROGRAM
    RENAL INFARCTION

    Cortical rim sign


    Differentiate from
    pyelonephritis
    RENAL AND PERINEPHRIC ABSCESS
    EMPHYSEMATOUS PYELONEPHRITIS
    • Emphysematous pyelonephritis (EPN) is an acute severe
    necrotizing infection of the renal parenchyma and its
    surrounding tissues that results in the presence of gas in the
    renal parenchyma, collecting system, or perinephric space

    • Escherichia coli. Other bacteria include Klebsiella pneumoniae,


    Proteus mirabilis and Pseudomonas aeruginosa

    • Life threatening complication of bacterial pyelonephritis may


    rapidly progress to septic shock. Patients are extremely ill and
    should be treated promptly
    CT features of emphysematous pyelonephritis can be
    differentiated into two types :
    •Type 1
    • greater than one-third renal parenchymal destruction
    • streaky or mottled appearance of gas

    •Type 2
    • destruction of less than one-third of the parenchyma
    INDIAN JOURNALOF ENDOCRINOLOGY AND METABOLISM JULY –
    AUGUST 2016

    Emphysematous pyelonephritis: A 10-year experience with 26 cases


    CONCLUSIONS OF STUDY
    • ALL DM PATIENTS
    • E COLI MOST FREQUENT PATHOGEN
    • NEARLY ALL WOMEN
    • CONSERVATIVE TREATMENT HAD A GOOD SUCCESS RATE 88.5 %
    • CONSIDER NEPHRECTOMY ONLY IN PATIENTS WHO DETERIORATE OR
    NO RESPONSE TO MEDICAL TREATMENT.
    Emphysematous pyelitis

    Emphysematous pyelitis
    is isolated gas production
    inside the excretory
    system, secondary to
    acute bacterial infection.
    It is a relatively benign
    entity and needs accurate
    differentiation from the
    far more serious
    emphysematous
    pyelonephritis.
    Emphysematous pyelitis and Cystitis
    EPN MIMIC
    Xanthogranulomatous pyelonephritis
    • First described by Schlagenhaufer in 1916, 0.6% of chronic
    pyelonephritis cases
    • Xanthogranulomatous pyelonephritis is an uncommon chronic
    destructive granulomatous process of renal parenchyma in association
    with long-term urinary tract obstruction and infection.
    • Usually secondary to staghorn calculus ( 70% ) and caused by Proteus
    or E.coli
    • Focal form or diffuse
    • CT scan finding of ‘Bear paw ’ sign
    • Histopathology shows Lipid laden foamy macrophage
    • Treatment : Nephrectomy
    •US: renal enlargement with pelvicalyceal dilatation,
    parenchymal destruction and multiple anechoic areas with
    hyperechogenic septa.

    •CT: multiloculated appearance (low density rounded areas


    throughout the enlarged left kidney): bear’s paw sign.
    MRI

    Hyperintense (or
    isointense) appearance of
    the solid component and
    hypointense cavity fluid
    on T1-weighted images.
    The administration of
    contrast material can
    reveal strong rim
    enhancement of the
    borders.
    • 52 studies (868 patients) over last 20 years included
    • 99.8% of patients underwent nephrectomy
    Tuberculosis characteristics
    • Hematogenous spread from a primary focus
    • Granuloma formation
    • Caseous necrosis
    • Cavitation
    • Fibrosis
    • Calcium deposition
    • Strictures formation which leads to chronic obstruction and renal
    dysfunction
    RENAL TUBERCULOSIS
    Early
    • Papillary necrosis (single or multiple) resulting in uneven caliectasis 

    Progressive

    • Multifocal strictures can affect any part of the collecting system


    • Hydronephrosis
    • Mural thickening and enhancement of ureter
    End-stage

    • Progressive hydronephrosis results in very thin parenchyma, scarring of cortex

    • Dystrophic calcification eventually involves the entire kidney (known as 


    putty kidney)
    Beaded ureter due to
    strictures
    Thimble bladder- term for
    extreme fibrosis and
    contracture of bladder​
    walls, resulting in a tiny
    bladder.
    MALAKOPLAKIA : Rare chronic inflammatory / granulomatous
    disease that most commonly affects genitourinary tract
    Patho physiology
    • Usually associated with infection due to gram negative bacteria esp E.coli and
    immunosuppression

    • Due to macrophage dysfunction

    • Basophilic intracytoplasmic inclusions in macrophages termed


    Michaelis-Gutmann  bodies

    • Symptoms consist of hematuria, dysuria , recurrent UTI

    • Cystoscopy and biopsy


    Fungal Infection
    • Fungal infection of the urinary tract is a severe life threatening
    infection particularly affecting patients with diabetes mellitus,
    haematological malignancy, HIV or other immunocompromised
    status.
    • Candida and Aspergillus and Mycor
    Multiple small hypoattenuating lesions and
    Fungal bezoar in right renal pelvis
    RARE COMPLICATIONS
    SEPTIC EMBOLI - embolization of infectious particles into lungs via
    pulmonary arteries
    RENAL VEIN THROMBOSIS
    MRI T2, T2 FATSAT
    Conclusions
    • Imaging (USS/CT) essential to rule out obstructive pyelonephritis

    • Imaging differentiation of emphysematous and xanthogranulomatous


    pyelonephritis may be difficult

    • Radiological manifestation of urinary TB wideranging

    • To consider rare type of infection in DM, immunocompromised patients

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