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Korean J Crit Care Med > Volume 28(4); 2013 > Article
Korean Journal of Critical Care Medicine 2013;28(4): 272-279. doi: https://doi.org/10.4266/kjccm.2013.28.4.272
급성 신우신염 환자에서 패혈성 쇼크와 관련 있는 신장 전산화단층촬영 소견
계명대학교 의과대학 동산의료원 응급의학과
Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock
Soonseong Kwon, Sangchan Jin, Wooik Choi, Sungjin Kim
Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. sjkim@dsmc.or.kr
BACKGROUND: Clinical findings, medical history and laboratory findings in patients with acute pyelonephritis are insufficient to predict the occurrence of septic shock and to assess its severity and prognosis. Early imaging may not only aid in diagnosing acute pyelonephritis, but also help in assessing the risk factors associated with septic shock. METHODS: In this retrospective study, we reviewed the medical records and collected the data of 200 patients from January to December, 2011. All patients were over 18 years old; showed symptoms of fever, chills, muscle pain and flank pain; demonstrated more than 10 white blood cells in urinalysis; and were diagnosed with acute pyelonephritis after computed tomography (CT) scan. Patients were classified into two groups: patients with septic shock (group 1) and patients without septic shock (group 2), and the clinical, laboratory and CT findings of the two groups were then compared. RESULTS: Out of all 200 patients, there were 32 patients (16%) who had acute pyelonephritis with septic shock. The acute pyelonephritis with septic shock group (group 1) showed increased bacteremia compared with the other group (53.1% vs. 24.4%, p = 0.002). Laboratory findings showed that group 1 patients had higher serum creatinine (1.67 +/- 1.03 mg/dl vs. 1.14 +/- 0.98 mg/dl, p = 0.022) and hsCRP (8.36 +/- 5.29 mg/dl vs. 5.27 +/- 3.53 mg/dl, p = 0.000) than group 2 patients. The findings of kidney CT showed statistically significant differences in global renal enlargement (31.3% vs. 18.7%, p = 0.005), pelvicalyceal wall thickening (37.5% vs. 13.1%, p = 0.005) and poor excretion of contrast (25% vs. 2.4%, p = 0.000). The results of the logistic regression test showed that there were significant differences in bacteremia serum creatinine, C-reactive protein, pelvicalyceal wall thickening and poor excretion of contrast. CONCLUSIONS: Computed tomography can predict the possibility of septic shock by identifying the range of renal lesions in patients with acute pyelonephritis. It can therefore allow initial aggressive treatment that can contribute to decreases in mortality and morbidity in patients with acute pyelonephritis.
Key Words: acute pyelonephritis; computed tomography; septic shock
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