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Tu J, Lin T, Li H, Chen C. Acute Focal Bacterial Nephritis without Pyuria: A Peculiar Subtype of Urinary Tract Infection. Pediatr Infect Dis J 2024:00006454-990000000-00940. [PMID: 38986009 DOI: 10.1097/inf.0000000000004469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Acute focal bacterial nephritis (AFBN) without pyuria is a subtype of urinary tract infection in children, often leading to diagnostic challenges. The clinical characteristics of 6 children diagnosed with AFBN, who exhibited an absence of pyuria, were retrospectively summarized and compared with the control group consisting of 49 hospitalized AFBN children with pyuria. The cases of AFBN without pyuria presented with more severe inflammatory responses and were predisposed to complications, such as sepsis and neurological abnormalities.
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Affiliation(s)
- Juan Tu
- From the Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
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Vaezipour N, Evers K, Schmid H, Ritz N, Goischke A. Is shorter antibiotic treatment duration increasing the risk of relapse in paediatric acute focal bacterial nephritis? Arch Dis Child 2024; 109:248-250. [PMID: 37949642 DOI: 10.1136/archdischild-2023-326054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Nina Vaezipour
- Department of Paediatric Infectious Diseases and Vaccinology, University Childrens Hospital Basel, Basel, Switzerland
- Mycobacterial and Migrant Health Research Group, University of Basel and Department of Clinical Research, Basel, Switzerland
| | - Katrina Evers
- Department of Paediatric Nephrology, University Childrens Hospital Basel, Basel, Switzerland
| | - Hanna Schmid
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel and Department of Clinical Research, Basel, Switzerland
- Department of Paediatrics and Paediatric Infectious Diseases, Childrens Hospital Lucerne and Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Paediatrics, The Royal Childrens Hospital Melbourne, University of Melbourne, Parkville, Victoria, Australia
| | - Alexandra Goischke
- Department of Paediatric Nephrology, University Childrens Hospital Basel, Basel, Switzerland
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Clinical features of acute focal bacterial nephritis in adults. Sci Rep 2022; 12:7292. [PMID: 35508538 PMCID: PMC9068887 DOI: 10.1038/s41598-022-10809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 04/12/2022] [Indexed: 11/08/2022] Open
Abstract
Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidneys presenting as an inflammatory mass that can develop into renal abscess. The current reports on AFBN mostly are among children and rarely described in adults. This study was aimed to analyze the clinical features of AFBN in adults and make a review for the disease to give the clinicians some clues to suspect and recognize it in adults. From January 2014 to December 2019, AFBN was diagnosed by contrast-enhanced computed tomography (CT) in 238 adults at the Department of Nephrology, the Second Hospital of Hebei Medical University, Shijiazhuang, China. We reviewed the clinical records of these patients and asked them about their post-discharge status via telephone follow-up. Of all the patients, 195 were female and 43 were male, the median age were 46.87 years. 86.13% presented with fever, 55.89% presented with lower urinary tract symptoms and 97.9% presented with pyuria. In renal ultrasonography, abdominal findings were seen only 22.69% patients. E.coli accounted for 74.73% of the isolated pathogen. After 4 weeks of treatment, the patients had no recurrence of symptoms. We recommend that when a patient presents clinically with acute pyelonephritis, but the fever persist longer after antimicrobial treatment (≥ 4 days in our study), AFBN should be suspected. For the diagnosis, contrast-enhanced CT is the “gold standard”, magnetic resonance imaging (MRI) may be a good option, but the ultrasonography is probably not satisfied. 3–4 weeks of antibiotic therapy may be appropriate for AFBN in adults.
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Kishimoto N, Mori Y, Yutaka T, Oishi E, Morita T. A case of acute focal bacterial nephritis with acute kidney injury presenting as acute abdomen. CEN Case Rep 2022; 11:386-390. [PMID: 35124791 DOI: 10.1007/s13730-022-00688-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/26/2022] [Indexed: 10/19/2022] Open
Abstract
Acute focal bacterial nephritis (AFBN) refers to the bacterial infection of the renal parenchyma without abscess formation. Although AFBN has mainly been reported in pediatric patients, it may be underdiagnosed in adults as it resembles acute pyelonephritis in its clinical presentation. However, the symptoms suggesting acute abdomen is an important clue to diagnose AFBN, which requires additional imaging studies such as contrast-enhanced computed tomography (CECT). Here, we present the case of a 49-year-old female presenting to our emergency room with acute abdomen as well as acute kidney injury (AKI). CECT was performed to rule out critical etiologies of severe abdominal pain and the results revealed multifocal wedge-shaped shadows in the right kidney and diffuse enlargement of bilateral kidneys. We diagnosed the patient with AFBN and treated her through temporal hemodialysis (two sessions) and antibiotics for 23 days. Although AKI associated with AFBN has rarely been reported, her renal dysfunction and other symptoms were completely improved. In conclusion, clinicians should be aware of AFBN and be cautious to avoid the unnecessary invasive interventions.
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Affiliation(s)
- Nao Kishimoto
- Division of Nephrology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitamura, Taisho-ku, Osaka, 551-0032, Japan
| | - Yasukiyo Mori
- Division of Nephrology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitamura, Taisho-ku, Osaka, 551-0032, Japan.
| | - Tomoko Yutaka
- Division of Nephrology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitamura, Taisho-ku, Osaka, 551-0032, Japan
| | - Emiko Oishi
- Division of Nephrology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitamura, Taisho-ku, Osaka, 551-0032, Japan
| | - Tatsunori Morita
- Division of Nephrology, Osaka Saiseikai Izuo Hospital, 3-4-5 Kitamura, Taisho-ku, Osaka, 551-0032, Japan
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Lucas García J, Oltra Benavent M, Ferrando Monleón S, Marín Sierra J, Rabasco Álvarez MD, Benito Julve P, Lucas García J, García Torres E, Olaya Alamar V, Nos Colom A, Oltra Benavent M, Lozano Zafra C, Caballero Chabrera F, Ferrando Monleón S, Marín Sierra J, Guzman Morais B, Rabasco Álvarez MD, Benito Julve P. Predictive markers of acute focal bacterial nephritis. A multicentre case-control study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Marcadores predictivos de nefritis focal bacteriana aguda. Estudio multicéntrico casos-control. An Pediatr (Barc) 2020; 93:77-83. [DOI: 10.1016/j.anpedi.2020.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/18/2022] Open
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Guella A, Khan A, Jarrah D. Acute Focal Bacterial Nephritis: Two Cases and Review of the Literature. Can J Kidney Health Dis 2019; 6:2054358119884310. [PMID: 31695922 PMCID: PMC6820168 DOI: 10.1177/2054358119884310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 08/26/2019] [Indexed: 11/21/2022] Open
Abstract
Rationale: Acute focal bacterial nephritis (AFBN) has mainly been reported in pediatrics. It may be an underdiagnosed condition in adults because it resembles acute pyelonephritis (APN) in its clinical presentation. Presenting concerns of the patients: Two young women (25 and 27 years old, respectively) presented with complaints compatible with a diagnosis of APN. However in both, fever was of high grade, persistent for several days in spite of antibiotic administration, and there was demonstrated worsening of the inflammatory biomarkers. A contrast-enhanced computed tomography (CECT) led to the diagnosis in both cases. Diagnoses: Contrast-enhanced computed tomography reveals the most sensitive and specific images of AFBN. This includes wedge-shaped lesions with decreased enhancement, which may be focal or multifocal. Interventions (including prevention and lifestyle): Antibiotic therapy for at least 3 weeks. Outcomes: Resolution of AFBN was obtained after 3 weeks of antibiotics. Lessons learned: Our 2 cases illustrate the importance of CECT imaging to confirm the diagnosis of AFBN. Interstitial bacterial inflammation may have a worse prognosis if not diagnosed early and efficiently treated. Unlike APN, the management of AFBN requires at least 3 weeks of antibiotics to prevent the development of renal scarring and renal abscess.
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Affiliation(s)
| | - Arshee Khan
- University Hospital Sharjah, United Arab Emirates
| | - Dima Jarrah
- University Hospital Sharjah, United Arab Emirates
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Mizutani M, Hasegawa S, Matsushige T, Ohta N, Kittaka S, Hoshide M, Kusuda T, Takahashi K, Ichihara K, Ohga S. Distinctive inflammatory profile between acute focal bacterial nephritis and acute pyelonephritis in children. Cytokine 2017; 99:24-29. [DOI: 10.1016/j.cyto.2017.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 12/24/2022]
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Campos-Franco J, Macia C, Huelga E, Diaz-Louzao C, Gude F, Alende R, Gonzalez-Quintela A. Acute focal bacterial nephritis in a cohort of hospitalized adult patients with acute pyelonephritis. Assessment of risk factors and a predictive model. Eur J Intern Med 2017; 39:69-74. [PMID: 27986362 DOI: 10.1016/j.ejim.2016.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/20/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute focal bacterial nephritis (AFBN) is a complicated form of acute pyelonephritis (APN) characterized by single or multiple areas of localised infection in the kidney without liquefaction or abscess. Studies investigating AFBN in adults are scarce. AIM The present study was aimed at evaluating the prevalence, associated factors, and presence of atypical clinical and radiological manifestations in adult AFBN patients. Also, we developed a clinical prediction model to evaluate the probability of AFBN in patients with APN. METHODS The clinical records of 377 patients (mean age 54years, 74.0% females) admitted to a hospital over a 5-year period with APN were reviewed. RESULTS A total of 57 cases of AFBN were radiologically identified (prevalence, 15.1%). Patients with AFBN were younger and displayed atypical manifestations more frequently than patients without AFBN; these included both clinical and radiological (pleural effusion, gallbladder wall thickening, fluid around the gallbladder, perirenal fluid, and ascites) manifestations. Patients with AFBN showed lower systolic blood pressure and needed more days of therapy to become afebrile, longer total duration of antibiotic therapy, and longer hospital stay than patients without AFBN. Contraceptive use was more frequent in patients with AFBN. A model based on five clinical variables showed good discrimination performance for the diagnosis of AFBN (Area under the curve, 0.77 (95% CI, 0.69-0.89)). CONCLUSIONS Patients with AFBN frequently present with atypical clinical and radiological manifestations. Clinical presentation by means of a predictive model may predict the presence of AFBN. Patients with AFBN need more intensive therapy, which is followed by a favourable outcome.
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Affiliation(s)
- Joaquin Campos-Franco
- Department of Internal Medicine, Hospital Clinico Universitario, Santiago de Compostela, Spain.
| | - Cristina Macia
- Department of Internal Medicine, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Emilio Huelga
- Department of Radiology, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Carla Diaz-Louzao
- Department of Clinical Epidemiology Unit, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Francisco Gude
- Department of Clinical Epidemiology Unit, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Rosario Alende
- Department of Internal Medicine, Hospital Clinico Universitario, Santiago de Compostela, Spain
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Role of Renal Ultrasonography in Predicting Vesicoureteral Reflux and Renal Scarring in Children Hospitalized with a First Febrile Urinary Tract Infection. Pediatr Neonatol 2016; 57:113-9. [PMID: 26163341 DOI: 10.1016/j.pedneo.2015.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/21/2015] [Accepted: 06/05/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study was designed to examine the capability of renal ultrasonography (US) for predicting vesicoureteral reflux (VUR) and renal scarring (RS), and to assess, using initial US, the significant urologic abnormalities that impact on management of children hospitalized with a first febrile urinary tract infection (UTI). METHODS Hospitalized children aged ≤ 2 years with a first febrile UTI were prospectively evaluated using imaging studies, including (99m)Tc dimercaptosuccinic acid (DMSA) scan, US, and voiding cystourethrography. RESULTS Of the 310 children analyzed (195 boys and 115 girls), 105 (33.9%) had abnormal US. Acute DMSA scans were abnormal in 194 children (62.6%), including 89 (45.9%) with concomitant abnormal US. There was VUR in 107 children (34.5%), including 79 (25.5%) with Grades III-V VUR. The sensitivity and negative predictive values of US were 52.3% and 75.1%, respectively, for Grades I-V VUR and 68.4% and 87.8%, respectively, for Grades III-V VUR. Eighty-five children (27.4%) had RS, including 55 (64.7%) with abnormal US. Of the 105 children with abnormal US, 33 (31.4%) needed subsequent management (surgical intervention, parental counseling, or follow up of renal function). Nephromegaly on initial US and Grades III-V VUR were risk factors of RS. CONCLUSION Abnormal US may carry a higher probability of Grades III-V VUR and RS, and can affect subsequent management in a significant number of children. Nephromegaly on initial US and Grades III-V VUR are strongly associated with an increased risk for RS. Thus, US should be performed on children after a first febrile UTI and children with normal US may not require voiding cystourethrography.
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Acute focal bacterial nephritis, pyonephrosis and renal abscess in children. Pediatr Nephrol 2015; 30:1987-93. [PMID: 26076753 DOI: 10.1007/s00467-015-3141-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND-AIM Acute focal bacterial nephritis (AFBN), renal abscess and pyonephrosis are uncommon and not fully addressed forms of urinary tract infection (UTI) which may be underdiagnosed without the appropriate imaging studies. Here, we review the characteristics and outcome of these renal entities in children managed at a single medial centre. PATIENTS AND METHODS The medical files of all children hospitalized for episodes of AFBN, renal abscess and pyonephrosis during a 10-year period (2003-2012) were reviewed. RESULTS Among the 602 children hospitalized for UTI, 21 presented with AFBN, one with abscess and three with pyonephrosis. All 25 children (13 girls), ranging in age from 0.06 to 13.4 years, were admitted with fever and an impaired clinical condition, and 18 had urological abnormalities. More than one lesion, often of different types, were identified in 11 episodes. Urine cultures from 13 episodes grew non-Escherichia coli pathogens and those from two episodes were negative. Antibiotics were administered for 14-60 days, and emergency surgery was required in three cases. During follow-up, 13 patients underwent corrective surgery. Permanent renal lesions were identified in 16 patients. CONCLUSIONS AFBN, renal abscess and pyonephrosis should be suspected in children with severe presentation and urological history. Appropriate imaging is crucial for management planning. Prognosis is often guarded despite appropriate treatment. Based on the results of this study we propose a management algorithm.
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Acute Focal Bacterial Nephritis Secondary to Vesicoureteric Reflux in a Young Boy. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2015. [DOI: 10.5812/pedinfect.26552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chen WL, Huang IF, Wang JL, Hung CH, Huang JS, Chen YS, Lee SSJ, Hsieh KS, Tang CW, Chien JH, Chiou YH, Cheng MF. Comparison of acute lobar nephronia and acute pyelonephritis in children: a single-center clinical analysis in southern taiwan. Pediatr Neonatol 2015; 56:176-82. [PMID: 25459491 DOI: 10.1016/j.pedneo.2014.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/13/2014] [Accepted: 08/04/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with acute lobar nephronia (ALN) require a longer duration of antimicrobial treatment than those with acute pyelonephritis (APN), and ALN is associated with renal scarring. The aim of this study was to provide an understanding of ALN by comparing the clinical features of pediatric patients with ALN and APN. METHODS We enrolled all of the patients with ALN (confirmed by computed tomography) admitted to our hospital from 1999 to 2012 in the ALN group. In addition, each patient diagnosed with APN who was matched for sex, age, and admission date to each ALN patient was enrolled in the APN group. The medical charts of patients in these two groups were retrospectively reviewed and analyzed for comparison. RESULTS The fever duration after hospitalization in the ALN group and the APN group were 4.85 ± 2.33 days and 2.30 ± 1.47 days respectively. The microbiological distributions and the majority of susceptibilities were similar in the ALN and APN groups. The majority of clinical manifestations are nonspecific and unreliable for the differentiation of ALN and APN. The patients with ALN were febrile for longer after antimicrobial treatment, had more nausea/vomiting symptoms, higher neutrophil count, bandemia, and C-reactive protein (CRP) levels, and lower platelet count (all p < 0.05). In multivariate analysis, initial CRP levels, nausea/vomiting symptoms, and fever duration after admission were independent variables with statistical significance to predict ALN. Severe nephromegaly occurred significantly more in the ALN group than in the APN group (p = 0.022). CONCLUSION The majority of clinical manifestations, laboratory findings, and microbiological features are similar between patients with ALN and APN. Clinicians should keep a high index of suspicion regarding ALN, particularly for those with ultrasonographic nephromegaly, initial higher CRP, nausea/vomiting, and fever for > 5 days after antimicrobial treatment.
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Affiliation(s)
- Wan-Ling Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, Pingtung Branch of Kaohsiung Veterans General Hospital, Pingtung, Taiwan
| | - I-Fei Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jiun-Ling Wang
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chih-Hsin Hung
- Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Jer-Shyung Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Wan Tang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Hung Chien
- Department of Pediatrics, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ming-Fang Cheng
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev 2014; 2014:CD003772. [PMID: 25066627 PMCID: PMC10580126 DOI: 10.1002/14651858.cd003772.pub4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Urinary tract infection (UTI) is one of the most common bacterial infections in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent kidney damage. There remains uncertainty regarding the optimum antibiotic regimen, route of administration and duration of treatment. This is an update of a review that was first published in 2003 and updated in 2005 and 2007. OBJECTIVES To evaluate the benefits and harms of antibiotics used to treat children with acute pyelonephritis. The aspects of therapy considered were 1) different antibiotics, 2) different dosing regimens of the same antibiotic, 3) different duration of treatment, and 4) different routes of administration. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register, CENTRAL, MEDLINE, EMBASE, reference lists of articles and conference proceedings without language restriction to 10 April 2014. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0 to 18 years with proven UTI and acute pyelonephritis were selected. DATA COLLECTION AND ANALYSIS Four authors independently assessed study quality and extracted data. Statistical analyses were performed using the random-effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). MAIN RESULTS This updated review included 27 studies (4452 children). This update included evidence from three new studies, and following re-evaluation, a previously excluded study was included because it now met our inclusion criteria.Risk of bias was assessed as low for sequence generation (12 studies), allocation concealment (six studies), blinding of outcome assessors (17 studies), incomplete outcome reporting (19 studies) and selective outcome reporting (13 studies). No study was blinded for participants or investigators. The 27 included studies evaluated 12 different comparisons. No significant differences were found in duration of fever (2 studies, 808 children: MD 2.05 hours, 95% CI -0.84 to 4.94), persistent UTI at 72 hours after commencing therapy (2 studies, 542 children: RR 1.10, 95% CI 0.07 to 17.41) or persistent kidney damage at six to 12 months (4 studies, 943 children: RR 0.82, 95% CI 0.59 to 1.12) between oral antibiotic therapy (10 to 14 days) and intravenous (IV) therapy (3 days) followed by oral therapy (10 days). Similarly, no significant differences in persistent bacteriuria at the end of treatment (4 studies, 305 children: RR 0.78, 95% CI 0.24 to 2.55) or persistent kidney damage (4 studies, 726 children: RR 1.01, 95% CI 0.80 to 1.29) were found between IV therapy (three to four days) followed by oral therapy and IV therapy (seven to 14 days). No significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (1 study, 179 children, persistent clinical symptoms at three days: RR 1.98, 95% CI 0.37 to 10.53). Adverse events were mild and uncommon and rarely resulted in discontinuation of treatment. AUTHORS' CONCLUSIONS This updated review increases the body of evidence that oral antibiotics alone are as effective as a short course (three to four days) of IV antibiotics followed by oral therapy for a total treatment duration of 10 to 14 days for the treatment of acute pyelonephritis in children. When IV antibiotics are given, a short course (two to four days) of IV therapy followed by oral therapy is as effective as a longer course (seven to 10 days) of IV therapy. If IV therapy with aminoglycosides is chosen, single daily dosing is safe and effective. Insufficient data are available to extrapolate these findings to children aged less than one month of age or to children with dilating vesicoureteric reflux (grades III-V). Further studies are required to determine the optimal total duration of antibiotic therapy required for acute pyelonephritis.
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Affiliation(s)
- Yvonne Strohmeier
- University of SydneyWestmead Clinical SchoolCnr Darcy Rd and Hawksbury RdWestmeadNSWAustralia2145
| | - Elisabeth M Hodson
- The Children's Hospital at WestmeadCentre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
- The University of SydneySydney School of Public HealthSydneyNSWAustralia2006
| | - Narelle S Willis
- The University of SydneySydney School of Public HealthSydneyNSWAustralia2006
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
| | - Angela C Webster
- The University of SydneySydney School of Public HealthSydneyNSWAustralia2006
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
- The University of Sydney at WestmeadCentre for Transplant and Renal Research, Westmead Millennium InstituteWestmeadNSWAustralia2145
| | - Jonathan C Craig
- The University of SydneySydney School of Public HealthSydneyNSWAustralia2006
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
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Kwong T, Coker C, Simpson E. A rare and unusual presentation of urological infection on a patient on steroids. BMJ Case Rep 2012; 2012:bcr-2012-007570. [PMID: 23239773 DOI: 10.1136/bcr-2012-007570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the rare case of adult lobar nephronia in a 49-year-old female, on long-term steroids with no prior urological or transplant history. More frequently reported in paediatric literature, adult lobar nephronia (focal pyelonephritis) is an unusual radiological finding sometimes preceding the development of renal abscess. We advocate that treatment should be a prolonged course of antibiotics and close follow-up.
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Affiliation(s)
- Tsong Kwong
- Department of Urology, Royal Sussex County Hospital, Brighton, UK.
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Cheng CH, Hang JF, Tsau YK, Lin TY. Nephromegaly is a significant risk factor for renal scarring in children with first febrile urinary tract infections. J Urol 2011; 186:2353-7. [PMID: 22019042 DOI: 10.1016/j.juro.2011.07.112] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE We determined whether nephromegaly on ultrasound can be used to identify patients with urinary tract infection at increased risk for renal scarring, and we investigated the effect of vesicoureteral reflux on renal scarring. MATERIALS AND METHODS We enrolled hospitalized patients with a first febrile urinary tract infection. All patients underwent renal ultrasound and most patients underwent voiding cystourethrography. Renal scarring was assessed using (99m)technetium dimercapto-succinic acid renal scintigraphy at least 6 months after treatment. Children with recurrent urinary tract infections before scintigraphy were excluded from the study. RESULTS A total of 545 children (80 with and 465 without nephromegaly) were enrolled. Infection was more severe in patients with than without nephromegaly. The incidence of renal scarring was significantly higher in patients with nephromegaly (90% vs 32%, p <0.001), in kidneys with nephromegaly (80.5% vs 18.7%, p <0.001) and in kidneys with vesicoureteral reflux (41.5% vs 22.2%, p <0.001). Kidneys with nephromegaly had a greater incidence of reflux. The finding of nephromegaly is associated with a greatly increased likelihood of renal scarring in patients with vesicoureteral reflux. CONCLUSIONS Our results indicate that ultrasound diagnosis of nephromegaly at onset is associated with a high incidence of renal scarring, and identification of nephromegaly at onset and vesicoureteral reflux are significant risk factors for renal scarring in children with a first febrile urinary tract infection. Nephromegaly is associated with an increased frequency of vesicoureteral reflux and increased likelihood of renal scarring in patients with reflux.
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Affiliation(s)
- Chi-Hui Cheng
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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