TREATMENT TACTICS OF PURULENT PYELONEPHRITIS ACCORDING TO THE RESULTS OF CT PERFUSION OF THE KIDNEYS

 

Ananiev V.A.¹, Lubyansky V.G.,² Petrenko V.G.³

 

1 - Regional Clinical Hospital.

2 - Altai State Medical University. Barnaul, Russia.

P

urpose. To develop criteria for the severity of renal parenchymal lesions and the pathological process by CT perfusion and to determine indications for conservative management, organ-preserving and organ-bearing treatment.

Materials and methods. For the period from 2022 to 2023, a study of 29 patients diagnosed with acute purulent pyelonephritis was carried out in the Department of Urology No2 of the Regional Clinical Hospital of Barnaul. The studies were carried out on a multispiral 128-slice computer tomograph "Revolution EVO", manufactured by General Electric (USA). Data analysis for the creation of the perfusion card was carried out using the installed CT Perfusion 4D Multi – Organs GE Healthcare program on the HP Z440 workstation.

Results. Diagnostic criteria for the choice of treatment tactics for patients with acute destructive pyelonephritis based on the analysis of generalized CT data of renal perfusion (patent No 2823858) were determined.

Criterion No1. With a decrease from the norm in the cortical layer of the kidney by AF by 11% or less and FE by 11% or less, and in the medullary layer with a decrease in AF by 4% or less, with a decrease in FE by 30% or less with a normal volume of blood filling in both layers, standard conservative therapy of acute pyelonephritis is considered indicated.

Criterion No2. With a decrease from the norm in the cortical layer of the kidney by AF by 45-71% and FE by 64-66%, and in the medullary layer with a decrease in AF by 6-62% and a decrease in FE by 31-53% with a normal volume of blood filling in both layers, an organ-preserving hybrid surgical technique is considered indicated (patent No 2620756 in 2017).

Criterion No3. With a decrease from the norm in the cortical layer of the kidney by AF by 72% or more, a decrease in BV by 75% or more, a decrease in FE by 67% or more, and in the medulla with a decrease in AF by 63% or more, a decrease in BV by 83% or more, and a decrease in FE by 54% or more, kidney removal is considered indicated.

Discussion. The proposed diagnostic method provides an objective assessment of both the functional and morphological state of the kidneys which helps to choose the most rational treatment strategy.

Conclusion. CT perfusion is a valuable method for objective assessment of blood flow in the kidney in patients with acute destructive pyelonephritis. The postoperative results obtained clearly showed that CT perfusions should be performed in patients at the preoperative stage in order to make a decision on the necessary management tactics. This study confirms the applicability of this method in the diagnosis and monitoring of the renal condition in this category of patients.

 

Keywords: acute purulent pyelonephritis, renal perfusion, CT perfusion, renal hemodynamics.

 

Corresponding author: Dariy O.IY., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Ananiev V.A., Lubyansky V.G., Petrenko V.G. Treatment tactics of purulent pyelonephritis according to the results of CT perfusion of the kidneys. REJR 2024; 14(3):69-78. DOI: 10.21569/2222-7415-2024-14-3-69-78.

Received:        03.02.24                 Accepted: 11.09.24