Unit 10 - Renal Infections

Infections can progress from ____________ to ______ ________ _________to _________.

Pyelonephritis

Focal bacterial nephritis

Abscess

What is this image showing?

An infection

Pus within collecting system?

Pyonephrosis

Pyonephrosis is associated with severe ________.

Urosepsis

Pyonephrosis is a …

Urologic emergency

A true urologic emergency requires…?

Urgent intravenous antibiotics therapy &/or percutaneous drainage

What is the sonographic appearance of Pyonephrosis?

• Low-level echoes

• Fluid – debris level

• Anechoic dilation may occur

What is this image showing?

Pyonephrosis

Acute Pyelonephritis is an ___________ infection, consisting of __ ______.

Ascending; E coli

Hematogenous seeding

Staphylococcus aureus

What is the prevalence of Acute Pyelonephritis?

• Females > Males

• Age 15-35 years old

What are the clinical findings of Acute Pyelonephritis?

• Flank pain

• Fever

• Bacteriuria

• Pyuria

• Leukocytosis

What is the sonographic appearance of Acute Pyonephrosis?

• Majority appear completely normal

• Renal enlargement

• Compression of renal sinus

  • Hypoechoic (edema)

  • Hyperechoic (hemorrhage)

• Loss of corticomedullary differentiation

Air in renal parenchyma?

Emphysematous Pyelonephritis

What is Emphysematous Pyelonephritis?

Diffuse gas forming parenchymal infection (E-coli)

Emphysematous Pyelonephritis happens ___________.

Unilaterally

Emphysematous Pyelonephritis could possibly need…

Emergency nephrectomy

What is the sonographic appearance of Emphysematous Pyelonephritis?

• Enlarged kidney(s) / inflamed

• Hypoechoic

• Gas artifact - ring down

Xanthogranulomatous Pyelonephritis is considered _____

Rare

Chronic obstruction & infection?

Xanthogranulomatous Pyelonephritis

Xanthogranulomatous Pyelonephritis can cause?

• Destruction of parenchyma

• Infiltration of lipid-laden histiocytes

What are the symptoms of Xanthogranulomatous Pyelonephritis?

• Large nonfunctioning kidney

• Multiple infections

• Staghorn calculus

What is Staghorn calculous?

A type of kidney stone that obtains its characteristic shape by forming a cast of the renal pelvis & calyces

• Resembling the horns of a male deer

What is the sonographic appearance of Xanthogranulomatous Pyelonephritis?

• Enlarged kidney

• Bright echogenicity from staghorn calculus

• Parenchyma replaced by cysts

• Diffuse or segmental