How is pyelonephritis primarily diagnosed?

• A. CT abdomen and pelvis without contrast
• B. Ultrasound of the kidneys
• C. Urine dip test
• D. X-ray of the pelvis

Answer: (A)

Pyelonephritis is primarily diagnosed through imaging studies, with a CT abdomen and pelvis without contrast being one of the most effective methods. This imaging technique allows for a detailed view of the kidneys and urinary tract and can help identify any complications such as abscess formation, obstruction, or anatomical abnormalities that might be contributing to the infection. It can also distinguish between pyelonephritis and other conditions that may present with similar symptoms.

While ultrasound of the kidneys can also be used, especially in certain circumstances such as during pregnancy or in patients with contraindications to CT scans, it is not as sensitive or specific in diagnosing pyelonephritis compared to a CT scan. The urine dip test can provide preliminary information regarding a urinary tract infection, such as the presence of leukocyte esterase or nitrites, but it does not confirm a diagnosis of pyelonephritis on its own. An X-ray of the pelvis is not typically used in the diagnostic process for pyelonephritis, as it does not provide detailed information about the kidneys or urinary tract compared to other imaging modalities.