Pediatric Nephrology

, Volume 30, Issue 11, pp 1987–1993 | Cite as

Acute focal bacterial nephritis, pyonephrosis and renal abscess in children

  • Maria Bitsori
  • Maria Raissaki
  • Sofia Maraki
  • Emmanouil GalanakisEmail author
Original Article



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.


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.


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.


Acute focal bacterial nephritis Pyonephrosis Renal abscess Magnetic resonance urography Non-E. coli pathogens 


Conflict of interest



  1. 1.
    Wald E (2004) Urinary tract infections in infants and children: a comprehensive overview. Curr Opin Pediatr 16:65–68CrossRefGoogle Scholar
  2. 2.
    Jahnukainen T, Chen M, Celsi G (2005) Mechanisms of renal damage owing to infection. Pediatr Nephrol 20:1043–1053CrossRefPubMedGoogle Scholar
  3. 3.
    Bitsori M, Maraki S, Raissaki M, Bakantaki A, Galanakis E (2005) Community-acquired enterococcal urinary tract infections. Pediatr Nephrol 20:1583–1586CrossRefPubMedGoogle Scholar
  4. 4.
    Cheng CH, Tsau YK, Lin TY (2006) Effective duration of antimicrobial therapy for the treatment of acute lobar nephronia. Pediatrics 117:e84–e89CrossRefPubMedGoogle Scholar
  5. 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 19:35–39PubMedGoogle Scholar
  6. 6.
    Sharma S, Mohta A, Sharma P (2004) Neonatal pyonephrosis—a case report. Int Urol Nephrol 36:313–315CrossRefPubMedGoogle Scholar
  7. 7.
    Rathore NH, Barton LL, Luisiri A (1991) Acute lobar nephronia: a review. Pediatrics 87:728–734PubMedGoogle Scholar
  8. 8.
    Cheng CH, Tsau YK, Hsu SY, Lee TL (2004) Effective ultrasonographic predictor for the diagnosis of acute lobar nephronia. Pediatr Infect Dis J 23:11–14CrossRefPubMedGoogle Scholar
  9. 9.
    Lavocat MP, Granjon D, Allard D, Gay C, Freycon MT, Dubois F (1997) Imaging of pyelonephritis. Pediatr Radiol 27:159–165CrossRefPubMedGoogle Scholar
  10. 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 27:1025–1027CrossRefPubMedGoogle Scholar
  11. 11.
    Cerwinka WH, Grattan-Smith D, Kirsch AJ (2008) Magnetic resonance urography in pediatric urology. J Pediatr Urol 4:74–83CrossRefPubMedGoogle Scholar
  12. 12.
    Rosenfield AT, Glickman MG, Taylor KJ, Crade M, Hodson J (1979) Acute focal bacterial nephritis (acute lobar nephronia). Radiology 132:553–561CrossRefPubMedGoogle Scholar
  13. 13.
    Lawson GR, White FE, Alexander FW (1985) Acute focal bacterial nephritis. Arch Dis Child 60:475–477PubMedCentralCrossRefPubMedGoogle Scholar
  14. 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 20:93–95CrossRefPubMedGoogle Scholar
  15. 15.
    Greenfield SP, Montgomery P (1987) Computerized tomography and acute pyelonephritis in children, a clinical correlation. Urology 29:137–140CrossRefPubMedGoogle Scholar
  16. 16.
    Kline MW, Kaplan SL, Baker CJ (1988) Acute focal bacterial nephritis: diverse clinical presentations in pediatric patients. Pediatr Infect Dis J 7:346–349CrossRefPubMedGoogle Scholar
  17. 17.
    Uehling DT, Hahnfeld LE, Scanlan KA (2000) Urinary tract abnormalities in children with focal bacterial nephritis. BJU Int 85:885–888CrossRefPubMedGoogle Scholar
  18. 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 128:850–853CrossRefPubMedGoogle Scholar
  19. 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 22:1897–1901CrossRefPubMedGoogle Scholar
  20. 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 43:207–214CrossRefPubMedGoogle Scholar
  21. 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 29:624–628CrossRefPubMedGoogle Scholar
  22. 22.
    Patel R, Nwokoma N, Ninan GK (2013) Primary neonatal MRSA pyonephrosis. Int Urol Nephrol 45:939–942CrossRefPubMedGoogle Scholar
  23. 23.
    National Institute for Health and Clinical Excellence (2007) Urinary tract infection in children: diagnosis, treatment and long-term management. Available at:
  24. 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 128:595–610CrossRefPubMedGoogle Scholar
  25. 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 28:300–303CrossRefGoogle Scholar
  26. 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 156:82–86CrossRefPubMedGoogle Scholar
  27. 27.
    Stojanovic MM, Micic SR, Milovanovic DR, Jancovic SM (2009) Risk factors for treatment failure in renal suppurative infections. Int Urol Nephrol 41:319–325CrossRefGoogle Scholar
  28. 28.
    Bitsori M, Maraki S, Koukouraki S, Galanakis E (2012) Pseudomonas aeruginosa urinary tract infection in children: risk factors and outcomes. J Urol 187:260–264CrossRefPubMedGoogle Scholar
  29. 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 101:451–457CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2015

Authors and Affiliations

  • Maria Bitsori
    • 1
  • Maria Raissaki
    • 2
  • Sofia Maraki
    • 3
  • Emmanouil Galanakis
    • 1
    Email author
  1. 1.Department of PaediatricsHeraklion University HospitalHeraklionGreece
  2. 2.Department of RadiologyHeraklion University HospitalHeraklionGreece
  3. 3.Department of Clinical MicrobiologyHeraklion University HospitalHeraklionGreece

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