3089 Radiological assessment of suspected acute pyelonephritis in the management of urosepsis and prevention of acute kidney injury

Abstract Background and Aims Sepsis, a serious complication of infection, may result in organ dysfunction and is responsible for almost 20% of global deaths. Identification of acute pyelonephritis (pyelo), requires early clinical assessment, diagnostics and antimicrobial therapy to prevent septic shock and potential death. In 2022, the American College of Radiology (ACR) published a revised appropriateness criteria for radiological imaging in suspected acute pyelo (1). Five variant [V] categories were defined according to presence of pregnancy, stone disease, renal transplantation, complicated (i.e. recurrent pyelo, DM, immunosuppression) and uncomplicated (first) presentation. The aim of this project was to establish the proportion of patients with suspected acute pyelonephritis undergoing radiological assessment, the selected modality and radiological findings, which could contribute to the diagnosis and management. Method This observational retrospective study of 55 cases with suspected acute pyelo over 6 months. Patients who were decanted to nephrology specialist care from the acute medical take were assessed. Patients were grouped into 5 categories [Variant 1-5] as per appropriateness criteria of the ACR (Table 1a). Patient demographics, renal function and signs of sepsis were recorded. The proportion undergoing radiological assessment, the modality and outcomes are outlined in Table 1. Results Demographically, 66% of patients were female, the median age was 49 years [IQR 30] and 93.6% were Caucasian. Pre-admission baseline Creatinine (Cr) was 75 µmol/l [IQR 75]. Admission Cr was 85 µmol/l [IQR 74}, with peak inpatient Cr 94 µmol/l. Sepsis parameters (hypotensive/ tachycardia/ high CRP) on admission were observed in 38% of patients. Modality Choice 92.7% of study participants received imaging over the course of their inpatient stay. The primary modality of choice was CTKUB (36.4%), with 25.5% of patients receiving targeted ultrasound. In the setting of uncomplicated acute pyelo (V1), CTKUB was the most common diagnostic modality. Patients with a history of renal calculi (V3) were imaged equally with CTKUB and targeted ultrasound (42.9% CTKUB vs. 42.9% USS). Patients with a history of renal transplant with a native kidney in-situ were most commonly investigated with targeted ultrasound to assess for acute pyelo 92.3%. Imaging Results 52.7% of imaging had positive findings. Most frequently recorded was pyelo (23.6%), renal/ureteric calculi (16.4%) and h