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Acute focal bacterial nephritis, pyonephrosis and renal abscess in children

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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 to13.4 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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References

  1. Wald E (2004) Urinary tract infections in infants and children: a comprehensive overview. Curr Opin Pediatr 16:65–68

    Article  Google Scholar 

  2. Jahnukainen T, Chen M, Celsi G (2005) Mechanisms of renal damage owing to infection. Pediatr Nephrol 20:1043–1053

    Article  PubMed  Google Scholar 

  3. Bitsori M, Maraki S, Raissaki M, Bakantaki A, Galanakis E (2005) Community-acquired enterococcal urinary tract infections. Pediatr Nephrol 20:1583–1586

    Article  PubMed  Google Scholar 

  4. Cheng CH, Tsau YK, Lin TY (2006) Effective duration of antimicrobial therapy for the treatment of acute lobar nephronia. Pediatrics 117:e84–e89

    Article  PubMed  Google Scholar 

  5. Angel C, Shu T, Green J, Orihuela E, Rodriguez G, Hendrick E (2003) Renal and peri-renal abscess in children: proposed physio-pathologic mechanisms and treatment algorithm. Pediatr Surg Int 19:35–39

    CAS  PubMed  Google Scholar 

  6. Sharma S, Mohta A, Sharma P (2004) Neonatal pyonephrosis—a case report. Int Urol Nephrol 36:313–315

    Article  PubMed  Google Scholar 

  7. Rathore NH, Barton LL, Luisiri A (1991) Acute lobar nephronia: a review. Pediatrics 87:728–734

    CAS  PubMed  Google Scholar 

  8. Cheng CH, Tsau YK, Hsu SY, Lee TL (2004) Effective ultrasonographic predictor for the diagnosis of acute lobar nephronia. Pediatr Infect Dis J 23:11–14

    Article  PubMed  Google Scholar 

  9. Lavocat MP, Granjon D, Allard D, Gay C, Freycon MT, Dubois F (1997) Imaging of pyelonephritis. Pediatr Radiol 27:159–165

    Article  CAS  PubMed  Google Scholar 

  10. Cheng CH, Tsai MH, Su LH, Wang CR, Lo WC, Tsau YK, Lin GJ, Huang YC, Chiu CH, Lin TY (2008) Renal abscess in children: a 10-year clinical and radiologic experience in a tertiary medical center. Pediatr Infect Dis J 27:1025–1027

    Article  PubMed  Google Scholar 

  11. Cerwinka WH, Grattan-Smith D, Kirsch AJ (2008) Magnetic resonance urography in pediatric urology. J Pediatr Urol 4:74–83

    Article  PubMed  Google Scholar 

  12. Rosenfield AT, Glickman MG, Taylor KJ, Crade M, Hodson J (1979) Acute focal bacterial nephritis (acute lobar nephronia). Radiology 132:553–561

    Article  CAS  PubMed  Google Scholar 

  13. Lawson GR, White FE, Alexander FW (1985) Acute focal bacterial nephritis. Arch Dis Child 60:475–477

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Shimizu M, Katayama K, Kato E, Miyayama S, Sugata T, Ohta K (2005) Evolution of acute focal bacterial nephritis into a renal abscess. Pediatr Nephrol 20:93–95

    Article  PubMed  Google Scholar 

  15. Greenfield SP, Montgomery P (1987) Computerized tomography and acute pyelonephritis in children, a clinical correlation. Urology 29:137–140

    Article  CAS  PubMed  Google Scholar 

  16. Kline MW, Kaplan SL, Baker CJ (1988) Acute focal bacterial nephritis: diverse clinical presentations in pediatric patients. Pediatr Infect Dis J 7:346–349

    Article  CAS  PubMed  Google Scholar 

  17. Uehling DT, Hahnfeld LE, Scanlan KA (2000) Urinary tract abnormalities in children with focal bacterial nephritis. BJU Int 85:885–888

    Article  CAS  PubMed  Google Scholar 

  18. Klar A, Hurvitz H, Berkun Y, Nadjari M, Blinder G, Israeli T, Halamish A, Katz A, Shazberg G, Branski D (1996) Focal bacterial nephritis (lobar nephronia) in children. J Pediatr 128:850–853

    Article  CAS  PubMed  Google Scholar 

  19. Seidel T, Kuwertz-Bröking E, Kaczmarek S, Kirschstein M, Frosch M, Bulla M, Harms E (2007) Acute focal bacterial nephritis in 25 children. Pediatr Nephrol 22:1897–1901

    Article  PubMed  Google Scholar 

  20. Yang CC, Shao PL, Lu CY, Tsau YK, Tsai IJ, Lee PI, Chang LY, Huang LM (2010) Comparison of acute lobar nephronia and uncomplicated urinary tract infection in children. J Microbiol Immunol Infect 43:207–214

    Article  PubMed  Google Scholar 

  21. Cheng CH, Tsau YK, Chang CJ, Chang YC, Kuo CY, Tsai IJ, Hsu YH, Lin TY (2010) Acute lobar nephronia is associated with a high incidence of renal scarring in childhood urinary tract infections. Pediatr Infect Dis J 29:624–628

    Article  PubMed  Google Scholar 

  22. Patel R, Nwokoma N, Ninan GK (2013) Primary neonatal MRSA pyonephrosis. Int Urol Nephrol 45:939–942

    Article  PubMed  Google Scholar 

  23. National Institute for Health and Clinical Excellence (2007) Urinary tract infection in children: diagnosis, treatment and long-term management. Available at: http://www.nice.org.uk/nicemedia/pdf/CG54fullguideline.pdf

  24. Roberts KB, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management (2011) Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 128:595–610

    Article  PubMed  Google Scholar 

  25. Cheng CH, Tsau YK, Chen SY, Lin TY (2011) Clinical courses of children with acute lobar nephronia correlated with computed tomographic patterns. Pediatr Infect Dis J 28:300–303

    Article  Google Scholar 

  26. Cheng CH, Tsau YK, Lin TY (2010) Is acute lobar nephronia the midpoint in the spectrum of upper urinary tract infections between acute pyelonephritis and renal abscess? J Pediatr 156:82–86

    Article  PubMed  Google Scholar 

  27. Stojanovic MM, Micic SR, Milovanovic DR, Jancovic SM (2009) Risk factors for treatment failure in renal suppurative infections. Int Urol Nephrol 41:319–325

    Article  Google Scholar 

  28. Bitsori M, Maraki S, Koukouraki S, Galanakis E (2012) Pseudomonas aeruginosa urinary tract infection in children: risk factors and outcomes. J Urol 187:260–264

    Article  CAS  PubMed  Google Scholar 

  29. Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G, Materassi M, Pecile P, Pennesi M, Pisanello L, Sica F, Toffolo A, Montini G (2012) Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr 101:451–457

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatrics, Heraklion University Hospital, POB 2208, Heraklion, 71003, Greece

    Maria Bitsori & Emmanouil Galanakis

  2. Department of Radiology, Heraklion University Hospital, Heraklion, Greece

    Maria Raissaki

  3. Department of Clinical Microbiology, Heraklion University Hospital, Heraklion, Greece

    Sofia Maraki

Authors
  1. Maria Bitsori
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  2. Maria Raissaki
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  3. Sofia Maraki
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  4. Emmanouil Galanakis
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Correspondence to Emmanouil Galanakis.

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Bitsori, M., Raissaki, M., Maraki, S. et al. Acute focal bacterial nephritis, pyonephrosis and renal abscess in children. Pediatr Nephrol 30, 1987–1993 (2015). https://doi.org/10.1007/s00467-015-3141-3

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  • DOI: https://doi.org/10.1007/s00467-015-3141-3

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