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Nothing Is Simple in Acute Pyelonephritis: A Pragmatic, Semantic Nephrologist’s View

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Imaging and Intervention in Urinary Tract Infections and Urosepsis

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Abstract

Acute pyelonephritis (APN) was first described over 2000 years ago. Despite this long history, many points remain open and will be addressed in this narrative review.

Firstly, there is no agreed definition of APN, and both a morphologic definition, based on imaging, and a clinical definition, as an upper urinary tract infection, are employed.

Secondly, in children, APN is treated as a parenchymal disorder, linked to vesicoureteral reflux, while in adults it is considered to be an upper urinary tract disorder, not requiring imaging confirmation.

Thirdly, the relationship between APN and predisposing factors is complex: complicated and noncomplicated pyelonephritis defines the presence of predisposing factors and not the effect of a severe disease.

Fourthly, the incidence and effect of kidney scars are not clear, and the balance between the side effects of long treatment and the advantages of avoiding scars has not yet been established.

In summary, different clinical definitions and diagnostic and therapeutic approaches are presently applied to APN. Prospective comparative studies are needed to clarify the management of this frequent, potentially dangerous disease.

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Authors and Affiliations

  1. Dipartimento Scienze cliniche e biologiche, Università di Torino, Regione Gonzole, Orbassano, TO, 10100, Italy

    Giorgina Barbara Piccoli

  2. Nephrologie, Centre Hospitalier Le Mans, Le Mans, France

    Giorgina Barbara Piccoli

  3. AOU San Luigi SCDU Urologia, AOU San Luigi, Regione Gonzole, Orbassano, TO, 10100, Italy

    Francesca Ragni

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  1. Giorgina Barbara Piccoli
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  2. Francesca Ragni
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Correspondence to Giorgina Barbara Piccoli .

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  1. Department of Radiology, Luigi Sacco Hospital, Milan, Italy

    Massimo Tonolini

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Piccoli, G.B., Ragni, F. (2018). Nothing Is Simple in Acute Pyelonephritis: A Pragmatic, Semantic Nephrologist’s View. In: Tonolini, M. (eds) Imaging and Intervention in Urinary Tract Infections and Urosepsis. Springer, Cham. https://doi.org/10.1007/978-3-319-68276-1_6

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  • DOI: https://doi.org/10.1007/978-3-319-68276-1_6

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