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However, the sensitivity of DMSA scan for acute pyelonephritis may be as low as 46%. [5] Procedure: Patient is injected with 2-5 mCi of Technetium-99m DMSA intravenously and static imaging is done using Gamma camera after 2-3 hours. Imaging time is approximately 5 - 10 minutes depending on the views taken.
Removal of the kidney is the best surgical treatment in the overwhelming majority of cases, although polar resection (partial nephrectomy) has been effective for some people with localized disease. [10] [33] Watchful waiting with serial imaging may be appropriate in rare circumstances. [34]
There are no comparative trials to determine the best course of action for renal infarction brought on by thromboemboli, in situ thrombosis, or renal artery dissection. Reported treatments include open surgery, endovascular therapy, endovascular therapy ( thrombolysis / thrombectomy with or without angioplasty ), and anticoagulation.
An intravenous pyelogram is used to look for problems relating to the urinary tract. [5] These may include blockages or narrowing, such as due to kidney stones, cancer (such as renal cell carcinoma or transitional cell carcinoma), enlarged prostate glands, and anatomical variations, [5] such as a medullary sponge kidney. [6]
It is generally not recommended to perform routine radiographic imaging on patients who have simple urinary tract infections. When patients do not improve quickly with appropriate antibiotics, however, appropriate radiographic studies help diagnose pyonephrosis, emphysematous pyelonephritis, and renal and/or perirenal abscesses. [7]
In terms of cause, almost any condition that involves ischemia can lead to renal papillary necrosis. A mnemonic for the causes of renal papillary necrosis is POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, cirrhosis of the liver, analgesia/alcohol use disorder, renal vein thrombosis, diabetes mellitus, and systemic vasculitis. [3]
CVA tenderness is often present in acute pyelonephritis. [ 5 ] [ 4 ] [ 6 ] [ 7 ] CVA tenderness may be present in patients who have a kidney stone , [ 8 ] [ 7 ] a stone in the ureter , [ 8 ] a ureteropelvic junction obstruction, [ 8 ] a kidney abscess , [ 8 ] a urinary tract infection , [ 9 ] and vesicoureteral reflux . [ 10 ]
As the AMA decided in April 1960, the Current Medical Terminology (CMT) handbook was first published in June 1962 – 1963 to standardize terminology of the Standard Nomenclature of Diseases and Operations (SNDO) and International Classification of Diseases (ICD), and for the analysis of patient records, and was aided by an IBM computer. [22]