Granata Antonio, Floccari Fulvio, Insalaco Monica, Clementi Anna, Di Lullo Luca, D'Amelio Alessandro, Zamboli Pasquale, Logias Francesco, Romano Marcello, Fiorini Fulvio
U.O.C. Nefrologia e Dialisi, Ospedale San Giovanni di Dio, Agrigento, Italy.
G Ital Nefrol. 2012 Nov-Dec;29 Suppl 57:S47-57.
Urinary tract infections (UTIs) are a common clinical problem, especially among women. Ultrasound assessment is indicated in case of complicated UTIs, in particular in children, pregnant women and patients with chronic kidney disease. Even though B-mode imaging alone is rarely diagnostic in case of particular kidney infections such as focal and multifocal acute pyelonephritis, Doppler and power-Doppler (PD) techniques are able to increase its sensitivity. Contrast-enhanced ultrasound (CEUS) further improves the signal-to-noise ratio, thus increasing the diagnostic accuracy of ultrasound in case of renal infectious disease. Recent studies performed on kidney transplant recipients have indeed demonstrated the high sensitivity and specificity of CEUS in diagnosing acute pyelonephritis. Moreover, ultrasonography is a useful diagnostic tool in case of kidney abscesses, emphysematous pyelonephritis, early phases of pyonephrosis, and in the evaluation and monitoring of echinococcal cysts. Ultrasound imaging is less specific in diagnosing xanthogranulomatous pyelonephritis, malacoplakia and renal tuberculosis. Finally, several authors recommend routine ultrasound assessment in HIV patients, given the high incidence of renal complications in this population of patients.
尿路感染（UTIs）是一个常见的临床问题，在女性中尤为常见。对于复杂性尿路感染，尤其是儿童、孕妇和慢性肾病患者，建议进行超声评估。尽管在某些特殊的肾脏感染（如局灶性和多灶性急性肾盂肾炎）中，仅B超成像很少能做出诊断，但多普勒和能量多普勒（PD）技术能够提高其敏感性。超声造影（CEUS）进一步提高了信噪比，从而提高了超声在肾脏感染性疾病中的诊断准确性。最近对肾移植受者进行的研究确实证明了CEUS在诊断急性肾盂肾炎方面具有高敏感性和特异性。此外，超声检查在肾脓肿、气肿性肾盂肾炎、肾积脓早期以及棘球蚴囊肿的评估和监测中是一种有用的诊断工具。超声成像在诊断黄色肉芽肿性肾盂肾炎、软斑病和肾结核方面特异性较低。最后，鉴于HIV患者中肾脏并发症的高发生率，几位作者建议对这类患者进行常规超声评估。
