Clinical Rule of van Nieuwkoop et al for Performing Imaging Studies in an Adult with a Febrile Uinary Tract Infection (UTI)

 

The prevalence of clinically relevant abnormalities of the urinary tract was 19% of unselected patients who underwent radiologic imaging.

 

Parameters:

(1) urine pH

(2) history of nephrolithiasis

(3) estimated glomerular filtration rate (GFR) in mL per minute per 1.73 sq meters BSA

 

Parameter	Finding	Points
urine pH	<7.0	0
	>= 7.0	1
history of nephrolithiasis	no	0
	yes	1
GFR	> 40 mL/min per 1.73 square m	0
	<= 40 mL/min per 1.73 square m	1

 

total score =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 3

• A cutoff score >= 1 was associated with clinically relevant radiologic findings.

 

Performance:

• The negative predictive value was 93%. A patient with a score of 0 may not benefit from imaging studies of the urinary tract.

• The positive predictive value was only 24%.

• The sensitivity and specificity are not very good except for the sensitivity of detecting urgent clinically relevant radiologic findings.