Original Article

Skin-to-Renal Pelvis Distance Predicts Costovertebral Angle Tenderness in Adult Patients with Acute Focal Bacterial Nephritis

Authors: Masahiro Kaneko, MD, Naoto Ishimaru, MD, PhD, Toshio Shimokawa, PhD, Takahiro Nakajima, MD, Yohei Kanzawa, MD, Hiroyuki Seto, MD, Saori Kinami, MD, PhD

Abstract

Objectives: The aim of this study was to examine whether the distance between the skin and the renal pelvis affects the detection of costovertebral angle (CVA) tenderness in patients with acute focal bacterial nephritis (AFBN).

Methods: We retrospectively reviewed the charts of our patients between April 2013 and June 2019 who were diagnosed as having AFBN. Diagnosis was based on ultrasound or computed tomography with contrast, revealing at least one wedge-shaped area of decreased vascularity and confirmation of fever not attributable to another condition.

Results: We extracted 23 cases, all Japanese (mean age 60.0 years old [range 45–81 years], 7 males, 16 females). CVA tenderness was present in 8 of these 23 patients. Receiver operating characteristic curves were drawn to evaluate the ability to differentiate skin-to-renal pelvis distance (SPD), body mass index, and age. Only SPD was a useful predictor of CVA tenderness, and 66 mm was determined as the optimal cutoff point (area under the receiver operating characteristic curve 0.858, 95% confidence interval 0.70–1.00). Logistic regression analysis was performed with CVA tenderness as a dependent variable, and SPD, body mass index, and age as explanatory variables. SPD was an independent predictive variable of CVA tenderness (P = 0.038, odds ratio 0.76, 95% confidence interval 0.590–0.986).

Conclusions: CVA tenderness showed low yield in the diagnosis of AFBN in patients with longer SPD. Its use for diagnosis in obese patients may therefore be limited.
Posted in: Nephrology and Urology25

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References

1. Campos-Franco J, Macia C, Huelga E, et al. Acute focal bacterial nephritis in a cohort of hospitalized adult patients with acute pyelonephritis. Assessment of risk factors and a predictive model. Eur J Intern Med 2017;39:69–74.
 
2. Conley SP, Frumkin K. Acute lobar nephronia: a case report and literature review. J Emerg Med 2014;46:624–626.
 
3. Cheng CH, Tsau YK, Lin TY. Effective duration of antimicrobial therapy for the treatment of acute lobar nephronia. Pediatrics 2006;117:e84–e89.
 
4. Dewolf WC, Fraley EE. Renal pain. Urology 1975;6:403–408.
 
5. Miller-Young JE, Duncan NA, Baroud G. Material properties of the human calcaneal fat pad in compression: experiment and theory. J Biomech 2002; 35:1523–1531.
 
6. Ogura T, Toda H, Kimura T, et al. Buffer property of muscle and fat tissue to impact force [in Japanese]. J Jpn Soc Exp Mech 2011;11:18–21.
 
7. Wang SC, Bednarski B, Patel S, et al. Increased depth of subcutaneous fat is protective against abdominal injuries in motor vehicle collisions. Annu Proc Assoc Adv Automot Med 2003;47:545–559.
 
8. Glodny B, Unterholzner V, Taferner B, et al. Normal kidney size and its influencing factors—a 64-slice MDCT study of 1.040 asymptomatic patients. BMC Urol 2009;9:19.
 
9. Hida M, Wakabayachi T, Kitamura M, et al [Studies on normal renal weight and size in Japanese]. Nihon Jinzo Gakkai Shi 1986;28:1393–1397.
 
10. El Tumi H, Johnson MI, Dantas PBF, et al. Age-related changes in pain sensitivity in healthy humans: a systematic review with meta-analysis. Eur J Pain 2017;21:955–964.
 
11. Sauvain MO, Tschirky S, Patak MA, et al. Acute appendicitis in overweight patients: the role of preoperative imaging. Patient Saf Surg 2016;10:13.
 
12. Torensma B, Oudejans L, van Velzen M, et al. Pain sensitivity and pain scoring in patients with morbid obesity. Surg Obes Relat Dis 2017;13: 788–795.
 
13. Bent S, Nallamothu BK, Simel DL, et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002;287:2701–2710.
 
14. Sieger N, Kyriazis I, Schaudinn A, et al. Acute focal bacterial nephritis is associated with invasive diagnostic procedures—a cohort of 138 cases extracted through a systematic review. BMC Infect Dis 2017;17:240.
 
15. Meister L, Morley EJ, Scheer D, et al. History and physical examination plus laboratory testing for the diagnosis of adult female urinary tract infection. Acad Emerg Med 2013;20:631–645.
 
16. Peterson J, Kaul S, Khashab M, et al. A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/ 500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology 2008;71:17–22.
 
17. Cheng CH, Tsau YK, Chen SY, et al. Clinical courses of children with acute lobar nephronia correlated with computed tomographic patterns. Pediatr Infect Dis J 2009;28:300–303.
 
18. Halm BM. Diagnosis of an acute lobar nephronia in the emergency department using point-of-care ultrasound. J Emerg Med 2019;57:227–231.
 
19. Beltramini A, Milojevic K, Pateron D. Pain assessment in newborns, infants, and children. Pediatr Ann 2017;46:e387–e395.