The role of renal scintigraphy in the evaluation of spinal cord injury patients with presumed urosepsis.

Abstract

We attempted to differentiate pyelonephritis, defined as upper urinary tract parenchymal infection, from fever due to other sources in patients with spinal cord injury by radioisotope renal scintigraphy. A total of 13 consecutive spinal cord injury patients 21 to 54 years old (level of injury C4 to cauda equina) was hospitalized with urosepsis. The diagnosis was based on medical history, physical examination and laboratory evaluation, including blood, urine, sputum and wound fluid culture and sensitivity, and a 99mtechnetium glucoheptonate renal scan for pyelonephritis. Renal scan results were compared to 1 or more of several studies performed in each case, including ultrasonography, excretory urography and axial computerized tomography. Glucoheptonate renal scintigraphy accurately diagnosed pyelonephritis in all 7 patients with a scintigraphic B lesion. In 2 patients with a C lesion on scintigraphy, representing a cortical scar, other sources of sepsis were identified. In the 4 patients with negative renal scans pyrexia was attributed to active decubitus wound infection and osteomyelitis. Positive and negative predictive values of renal scanning were each 100%. Nuclear medicine renal scanning is a valuable adjunct in the evaluation of sepsis and presumed urosepsis in the spinal cord injury population.