Comparison of Clinical Feature and Prognosis between Unilateral and Bilateral Acute Pyelonephritis

ABSTRACT

PURPOSE: Acute pyelonephritis (APN) usually presents as a mild disease. However, it has been shown to cause substantial morbidity and mortality on occasion. Therefore, it is important to distinguish between the complicated and uncomplicated APN. The purpose of this study was to determine the clinical significance of bilateral APN compared with unilateral APN in the emergency department (ED). METHODS: We analyzed the data of 303 consecutive patients with APN who underwent a abdominal computed tomography (CT) examination in the ED from January 2012 to December 2014. We compared the clinical presentation, progress, and outcomes between the unilateral and bilateral APNs that were identified on the CT scan. RESULTS: Of these 303 patients, 110 patients (36.3%) were confirmed as bilateral APN by the CT. The proportion of male was higher in the bilateral APN group (20.0% vs. 10.9%, p=0.029). Moreover, patients in the bilateral group visited the ED post symptom onset (6.5±7.8 vs. 3.6±3.1, p<0.001). However, symptom, sign, laboratory test, and CT findings were not statistically different between the two groups. In addition, severity, resistant pathogen, and outcomes such as occurrence of septic shock, hospital days, and mortality were also not different. CONCLUSION: This study suggests that bilateral APN, as determined by a CT, does not have clinical significance compared with unilateral APN.