Editing Pyelonephritis (section)

===Imaging studies===
If a kidney stone is suspected (e.g. on the basis of characteristic [[Renal colic|colicky pain]] or the presence of a disproportionate amount of blood in the urine), a [[kidneys, ureters, and bladder x-ray]] (KUB film) may assist in identifying [[radiodensity|radioopaque]] stones.<ref name=Ramakrishnan2005/> Where available, a noncontrast [[Helical cone beam computed tomography|helical CT scan]] with 5{{nbsp}}millimeter sections is the diagnostic modality of choice in the radiographic evaluation of suspected nephrolithiasis.<ref name=Pearle2007>{{cite book| vauthors = Pearle MS, Calhoun EA, Curhan GC | veditors = Litwin MS, Saigal CS |title=Urologic Diseases in America (NIH Publication No. 07–5512)|chapter=Chapter 8: Urolithiasis|pages=283–319|publisher=US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases|location=Bethesda, Maryland|year=2007|chapter-url=http://kidney.niddk.nih.gov/statistics/uda/Urolithiasis-Chapter08.pdf|url-status=live|archive-url=https://web.archive.org/web/20110915045339/http://kidney.niddk.nih.gov/statistics/uda/Urolithiasis-Chapter08.pdf|archive-date=15 September 2011}}</ref><ref name=SmithCentennial2000>{{cite journal | vauthors = Smith RC, Varanelli M | title = Diagnosis and management of acute ureterolithiasis: CT is truth | journal = AJR. American Journal of Roentgenology | volume = 175 | issue = 1 | pages = 3–6 | date = July 2000 | pmid = 10882237 | doi = 10.2214/ajr.175.1.1750003 | s2cid = 73387308 }}</ref><ref name=Fang2009>{{cite book| vauthors = Fang LS | veditors = Goroll AH, Mulley AG |title=Primary care medicine: office evaluation and management of the adult patient|edition=6th|chapter=Chapter 135: Approach to the Paient with Nephrolithiasis|pages=962–7|publisher=Lippincott Williams & Wilkins|location=Philadelphia|year=2009|isbn=978-0-7817-7513-7 |chapter-url=https://books.google.com/books?id=bIZvJPcSEXMC&q=nephrolithiasis+%22physical+examination%22&pg=PA964}}</ref> All stones are detectable on CT scans except very rare stones composed of certain drug residues in the urine.<ref name=Pietrow2006>{{cite journal | vauthors = Pietrow PK, Karellas ME | title = Medical management of common urinary calculi | journal = American Family Physician | volume = 74 | issue = 1 | pages = 86–94 | date = July 2006 | pmid = 16848382 | url = http://www.aafp.org/afp/2006/0701/p86.pdf | url-status = live | archive-url = https://web.archive.org/web/20111123060406/http://www.aafp.org/afp/2006/0701/p86.pdf | archive-date = 23 November 2011 }}</ref> In patients with recurrent ascending urinary tract infections, it may be necessary to exclude an anatomical abnormality, such as vesicoureteral reflux or [[polycystic kidney disease]]. Investigations used in this setting include [[Renal ultrasonography|kidney ultrasonography]] or [[voiding cystourethrogram|voiding cystourethrography]].<ref name=Ramakrishnan2005/> CT scan or kidney ultrasonography is useful in the diagnosis of xanthogranulomatous pyelonephritis; serial imaging may be useful for differentiating this condition from kidney cancer.<ref name=Korkes2008/>

[[File:Ultrasonography of acute pyelonephritis.jpg|thumb|Acute pyelonephritis with increased cortical echogenicity and blurred delineation of the upper pole<ref name=Hansen2015>Content initially copied from: {{cite journal | vauthors = Hansen KL, Nielsen MB, Ewertsen C | title = Ultrasonography of the Kidney: A Pictorial Review | journal = Diagnostics | volume = 6 | issue = 1 | pages = 2 | date = December 2015 | pmid = 26838799 | pmc = 4808817 | doi = 10.3390/diagnostics6010002 | doi-access = free | title-link = doi }}{{Creative Commons text attribution notice|cc=by4}}</ref>]]
Ultrasound findings that indicate pyelonephritis are enlargement of the kidney, edema in the renal sinus or parenchyma, bleeding, loss of corticomedullary differentiation, abscess formation, or an areas of poor blood flow on [[doppler ultrasound]].<ref name="CraigWagner2008">{{cite journal | vauthors = Craig WD, Wagner BJ, Travis MD | title = Pyelonephritis: radiologic-pathologic review | journal = Radiographics | volume = 28 | issue = 1 | pages = 255–276 | year = 2008 | pmid = 18203942 | doi = 10.1148/rg.281075171 | doi-access = free | title-link = doi }}</ref> However, ultrasound findings are seen in only 20–24% of people with pyelonephritis.<ref name="CraigWagner2008"/>

A [[DMSA scan]] is a radionuclide scan that uses dimercaptosuccinic acid in assessing the kidney morphology. It is now{{when|date=July 2019}} the most reliable test for the diagnosis of acute pyelonephritis.<ref>{{cite journal | vauthors = Goldraich NP, Goldraich IH | title = Update on dimercaptosuccinic acid renal scanning in children with urinary tract infection | journal = Pediatric Nephrology | volume = 9 | issue = 2 | pages = 221–6; discussion 227 | date = April 1995 | pmid = 7794724 | doi = 10.1007/bf00860755 | s2cid = 34078339 }}</ref>