COMBINED USE OF THE PASTERNATSKY SIGN AND URINALYSIS INDICATORS: SCREENING FOR PYELONEPHRITIS IN PRIMARY CARE

Acute pyelonephritis is an upper urinary tract infection that may rapidly progress to systemic illness if recognition and treatment are delayed. In first-contact clinical practice, decision-making often relies on physical examination and point-of-care urine testing, yet each component can be insufficient when applied in isolation. This pilot diagnostic accuracy study evaluated a pragmatic combined screening approach using costovertebral angle tenderness elicited by percussion (Pasternatsky sign) together with dipstick urinalysis indicators, specifically leukocyte esterase and nitrite, to support early identification of suspected acute pyelonephritis. Adults presenting with fever and or flank pain accompanied by urinary symptoms were assessed using bedside percussion tenderness and dipstick testing, and findings were compared with a final clinical diagnosis supported by urine culture and imaging when clinically indicated. In a cohort of 200 participants, 60 met the reference standard for acute pyelonephritis. The combined approach demonstrated higher overall screening performance than either physical examination or dipstick testing alone, with a high negative predictive value, suggesting utility for ruling out acute pyelonephritis in low-to-moderate risk presentations and guiding triage for confirmatory evaluation and timely management.急性肾盂肾炎（acute pyelonephritis）是一类上尿路感染，若延误识别与治疗，可快速进展为全身性疾病。在首诊临床实践中，临床决策通常依托体格检查与床旁尿液检测，但单独应用任一手段时均存在局限性。本先导诊断准确性研究评估了一种实用型联合筛查方案：采用叩诊诱发的肋脊角压痛（帕斯捷尔纳克征，Pasternatsky sign）结合试纸尿液分析指标——具体为白细胞酯酶与亚硝酸盐——以辅助早期疑似急性肾盂肾炎的识别。研究纳入出现发热或胁腹痛并伴随泌尿系统症状的成年受试者，对其实施床旁叩诊压痛检查与试纸检测，并将检测结果与经尿培养及临床指征明确时影像学检查确认的最终临床诊断进行对比。在200名受试者组成的队列中，60名符合急性肾盂肾炎的金标准诊断。联合筛查方案的整体筛查性能优于单独的体格检查或试纸检测，且具有较高的阴性预测值，提示该方案可用于在低至中度风险的就诊病例中排除急性肾盂肾炎，从而指导分诊以开展确认性评估与及时诊疗。