Headache attributed to acute pyelonephritis

Objective: This study identified the incidence and risk factors for headache attributed to acute pyelonephritis. Methods: The inclusion criteria were patients who were admitted with acute pyelonephritis at our hospital and ≥ 18 years of age. The following exclusion criteria were used: 1) patients who could not express their headache because of mental deterioration, 2) the presence of meningitis or meningoencephalitis, or 3) structural lesions on brain computed tomography or magnetic resonance images that could cause headache. The primary outcome was headache attributed to acute pyelonephritis as a dependent variable. The differences were analyzed using demographic and laboratory profiles as independent variables. Additionally, correlation analysis was performedbetweenseverity of headache using VAS score and demographic and laboratory profiles including age, WBC, and CRP. Results: A total of 479 patients met the inclusion criteria for this study, and 97 patients developed headache attributed to acute pyelonephritis. Patients with headache were younger and more likely to be female, and had a lower incidence of diabetes than those without headache. However, laboratory profiles that reflected the severity of acute pyelonephritis were not predictive factors for headache. Multiple logistic regression analysis demonstrated that young age and non-diabetes were independently significant variables for the prediction of headache attributed to acute pyelonephritis. In addition, the VAS score was found to be negative correlated with age, whereas it was not correlated with WBC and CRP. Conclusions: We determined that headache attributed to acute pyelonephritis was relatively common, and it was related to demographic characteristics but not acute pyelonephritis severity. Neurology Asia 2016; 21(2) : 155 – 160 Address for Correspondence: Kang Min Park, M.D., Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 612-030 Korea. Tel: +82-51-797-1195, E-mail: [email protected] INTRODUCTION Urinary tract infection (UTI) is one of the most frequent bacterial infections in all age groups. Acute pyelonephritis (APN) is a severe form of upper UTI, and it often requires hospitalization. The typical symptoms of APN include high-grade fever, flank pain, urinary frequency, and dysuria, and the mortality rate of APN ranges from 10 to 20%. However, unusual presentations of APN are common, and some patients may lack the typical APN symptoms. The absence of typical APN symptoms can be present in patients with complicating features, such as a history of recurrent UTI, diabetes mellitus, pregnancy, male gender, and immunosuppression. Moreover, clinicians sometimes conduct lumbar puncture for suspected meningitis in patients with APN because of the ambiguity of symptoms, such as headache, fever, and vomiting, which suggest meningeal or intracranial pathology. Lumbar puncture is the most valuable procedure to establish the diagnosis, and it is performed whenever the disease is suspected. However, lumbar puncture has some complications, such as post-dural puncture headache, bleeding, and infection. Therefore, knowledge of the incidence and risk factors for headache attributed to APN is required to avoid unnecessary lumbar puncture in patients without meningitis. We also commonly encounter patients with APN who complain of headache during hospitalization. To our knowledge, there have been no previous studies describing headache attributed to APN. This study identified the incidence and risk factors for headache attributed to APN.