For this variant, we assumed there are no contraindications to IV contrast agents. CT Abdomen and Pelvis There is no current literature specific to the use of CT of the abdomen and pelvis in the evaluation of suspected APN in a patient with a pelvic renal transplant and native kidneys in situ. CT of the abdomen and pelvis would include imaging of the native and transplant kidneys, and CT with IV contrast is highly accurate for the diagnose APN in a complicated patient, particularly if symptoms persist or worsen after 72 hours have passed [1,8,14-21]. Both unenhanced and contrast-enhanced CT are able to detect urolithiasis, perinephric fluid, renal swelling, and hydronephrosis [1,8,14,17-19]. Contrast-enhanced CT has been shown to improve detection of APN parenchymal changes, a renal abscess, and extrarenal acute conditions that may clinically present as suspicious for APN. CT imaging of the pelvis can detect potential pelvic abnormalities including urolithiasis in the distal ureters or urinary bladder, congenital abnormalities of the distal ureters and abnormal insertion sites, and abnormalities of the urinary bladder, among other potential sources of APN. Of note, unenhanced CT has higher sensitivity than contrast- enhanced CT for detection of small renal calculi. CT Abdomen There is no current literature to support the use of CT of the abdomen in the evaluation of suspected APN in a patient with a pelvic renal transplant and native kidneys in situ. APN of a renal allograft is more common than APN of the native kidneys, and renal transplant recipients are at high risk for complications from a variety of factors, including immunosuppression [52]. CT of the abdomen would not include complete imaging of the pelvic transplant kidney(s), which might miss important pathology in the transplant kidney [1,8,14-21]. CTU CTU There is limited information on the benefit of CTU for detection of suspected APN in a patient with a pelvic renal transplant and native kidneys in situ.
Acute Pyelonephritis. For this variant, we assumed there are no contraindications to IV contrast agents. CT Abdomen and Pelvis There is no current literature specific to the use of CT of the abdomen and pelvis in the evaluation of suspected APN in a patient with a pelvic renal transplant and native kidneys in situ. CT of the abdomen and pelvis would include imaging of the native and transplant kidneys, and CT with IV contrast is highly accurate for the diagnose APN in a complicated patient, particularly if symptoms persist or worsen after 72 hours have passed [1,8,14-21]. Both unenhanced and contrast-enhanced CT are able to detect urolithiasis, perinephric fluid, renal swelling, and hydronephrosis [1,8,14,17-19]. Contrast-enhanced CT has been shown to improve detection of APN parenchymal changes, a renal abscess, and extrarenal acute conditions that may clinically present as suspicious for APN. CT imaging of the pelvis can detect potential pelvic abnormalities including urolithiasis in the distal ureters or urinary bladder, congenital abnormalities of the distal ureters and abnormal insertion sites, and abnormalities of the urinary bladder, among other potential sources of APN. Of note, unenhanced CT has higher sensitivity than contrast- enhanced CT for detection of small renal calculi. CT Abdomen There is no current literature to support the use of CT of the abdomen in the evaluation of suspected APN in a patient with a pelvic renal transplant and native kidneys in situ. APN of a renal allograft is more common than APN of the native kidneys, and renal transplant recipients are at high risk for complications from a variety of factors, including immunosuppression [52]. CT of the abdomen would not include complete imaging of the pelvic transplant kidney(s), which might miss important pathology in the transplant kidney [1,8,14-21]. CTU CTU There is limited information on the benefit of CTU for detection of suspected APN in a patient with a pelvic renal transplant and native kidneys in situ.