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Objective To identify predictive factors of urological complication on imaging findings in women with pyelonephritis aged 18 to 65 years. Methods We performed an observational, retrospective, single-center study. The medical charts of women diagnosed with pyelonephritis at the emergency department from 2010 to 2015 were reviewed. Only patients who underwent an imaging study at the emergency department and with microbiologically confirmed pyelonephritis were included for analysis. The primary endpoint was the presence of urological complications on imaging findings. The secondary endpoint was treatment changes after imaging diagnosis. Results Of the 193 women enrolled, 88 (45.6%) had urological complication(s) on imaging findings. The multivariate analysis revealed that history of urolithiasis (OR = 2.41; P = 0.01) and pain requiring morphine use (OR = 5.29; P = 0.009) were predictive of urological complications on imaging findings. Of the 120 women with uncomplicated pyelonephritis who underwent imaging studies, 45% had urological complication, resulting in a treatment change in 36.7% of patients. The multivariate analysis revealed that age > 40 years (OR = 4.58; P = 0.02) and pain requiring morphine use (OR = 3.78; P = 0.02) were predictive of urological complication(s) on imaging findings and of treatment change based on imaging findings (OR = 6.76; P = 0.005 and OR = 4.19; P = 0.01 respectively) in this subgroup. Conclusions Pain requiring morphine use, age, and history of urolithiasis are independent predictors of urological complications on imaging findings in patients with acute pyelonephritis.

International audience; Background: Recommendations for the management of urolithiasis in primary care are lacking in France. The Delphi method was used to seek consensus from an expert panel regarding outpatient management of urolithiasis. Methods: We gathered 25 French experts from five clinical specialties: general practice, urology, nephrology, emergency medicine and radiology. The first survey was formulated after an exhaustive literature review. At each of the three rounds, the experts were given the results of the previous round and were asked again to complete the survey. The threshold of 70% of the vote was taken as defining consensus. A final round of validation involving five additional general practitioners was conducted. Results: Twenty experts participated in the study (five urologists, four nephrologists, four general practitioners, four emergency physicians, and three radiologists, participation rate = 80%). According to the survey results, most patients could be treated as outpatients (70.5% of the votes) but a biological (urine dipstick and culture, serum creatinine +/- serum beta-hcg) and imaging (renal ultrasound+Kidney-Ureters-Bladder X-ray or low-dose CT san) work-up is recommended within 24hours. Non-steroidal anti-inflammatory drugs are the analgesics of choice. An aetiological work-up should be performed after the second episode of renal colic. A follow-up imaging should be carried out yearly in urolithiasis patients. Conclusion: With the use of the Delphi method, we propose a multidisciplinary recommendation for the management of urolithiasis patients in primary care.

ObjectivesUnenhanced computed tomography (CT) has become a standard imaging technique for uncomplicated renal colic in many countries. The appropriate timing of CT imaging has not been established, and guidelines recommend that this imaging be performed between 1 and 7 days of presentation. The primary objective of this study was to determine the prevalence of alternative diagnosis identified with low-dose unenhanced CT in the emergency department (ED) in patients with suspected uncomplicated renal colic.MethodsThis prospective single-centre study was carried out in a large university hospital ED. Over a 6-month period, all patients with clinically diagnosed renal colic and a plan to be discharged underwent low-dose unenhanced CT in the ED. Pregnant women, women of childbearing age not willing to have a pregnancy test, and patients who had already undergone diagnostic imaging were excluded. The primary outcome was the number and nature of the alternative diagnosis. Univariate analyses were performed to assess factors associated with the primary outcome.ResultsA total of 178 patients were screened, and 155 underwent CT in the ED. The mean age was 42.2 years; 69% were male. The diagnosis of uncomplicated renal colic was confirmed in 118 participants (76%); 27 (17%) had an inconclusive CT scan. Overall, 10 patients (6%; 95% confidence interval [CI] 3–10) had an alternative diagnosis, 5 of whom were subsequently hospitalized.ConclusionLow-dose unenhanced CT in the ED detects alternative diagnoses in 6% (95% CI 3–10) of patients with suspected uncomplicated renal colic, half of whom are subsequently hospitalized. Our prospective findings, which were similar to those reported in retrospective studies, are a potential argument for a systematic approach to ED imaging in suspected renal colic. Future research involving intervention and control groups would be helpful.