Sobre la terminología de la infección renal aguda en adultos: papel del médico radiólogo en su identificación y diagnóstico por imagen, con énfasis en TC

Introduction: urinary tract infections (UTIs) are common bacterial infections with heterogeneous clinical phenotypes ranging from benign, uncomplicated infections to complicated UTIs and pyelonephritis, and even severe urosepsis. Imaging in renal infections is complex, given the nature of the findings in most cases. Careful assessment of the clinical situation is essential to accurately select the most informative imaging technique, and therefore, that information must be as precise as possible. Objective: given the diverse existing nomenclature and the agreement reached by the Society of Uroradiology in 1994, which recommended a simplified nomenclature based on the traditional and widely understood term acute pyelonephritis (APN), our objective is to emphasize and reinforce this nomenclature with current evidence. Material and methods: a prospective review spanning two years and three months, with clinicopathological correlation, included patients with non-contrast CT (NCCT) and post-contrast CT (PCCT) studies. The analysis examined the terminology used in describing CT findings and their respective reports, emphasizing both the findings described and the final impression. Results: different and diverse nomenclatures were defined, some of them confusing and lacking a clear context. Pneumonia can manifest as asymmetric perinephric distension or mild renal enlargement in moderate to severe infections. On post-contrast CT (PCCT), pneumonia may appear as wedge-shaped areas of low attenuation with poor corticomedullary differentiation, indicating hypoperfusion and edema. Late-phase images may also show renal sinus obliteration, striated nephrograms, and other findings. More serious complications of pneumonia, such as renal or perinephric abscesses, have been observed. Conclusions: in our study of patients and their cases, it was identified that a point of agreement should be strengthened and established so that the respective reports, findings, and final impressions adhere to an already accepted and recognized terminology. CT is very sensitive for detecting pyelonephritis and defining its extent, but it is not essential for early, uncomplicated pyelonephritis. Clinical use of CT may be appropriate in cases of persistent fever and leukocytosis that last more than 7 days despite antibiotic treatment.