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Pyelonephritis

Most people don't perform bedside US for pyelonephritis as the kidneys usually look normal (1) . If the patient has a UTI and severe pain, it is best to do a CTKUB because US may miss small stones or the patient may not have hydronephrosis due to dehydration or incomplete obstruction. 

The most common US finding I see in pyelonephritis is perinephric fluid: an anechoic stripe deep to Gerota's fascia. 

I use renal US in the undifferentiated septic patient looking for a renal abscess or hydronephrosis prior to CT so I can target my management better. 

Things to look for:

1. Loss of normal renal architecture

2. Abscess formation: fluid filled areas in the kidney

3. Avascuar areas suggesting renal infarction

4. Debris (echogenic material) in the collecting system

5. Hyperechoic locules in the collecting system: air from emphesematous pyelonephristis

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REFERENCES

1. June CH, Browning MD, Smith LP, Wenzel DJ, Pyatt RS, Checchio LM, Amis ES Jr. Ultrasonography and computed tomography in severe urinary tract infection. Arch Intern Med. 1985 May;145(5):841-5