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Pediatric Nephrology

, Volume 31, Issue 8, pp 1253–1265 | Cite as

Acute pyelonephritis in children

  • William Morello
  • Claudio La Scola
  • Irene Alberici
  • Giovanni MontiniEmail author
Educational Review

Abstract

Acute pyelonephritis is one of the most serious bacterial illnesses during childhood. Escherichia coli is responsible in most cases, however other organisms including Klebsiella, Enterococcus, Enterobacter, Proteus, and Pseudomonas species are being more frequently isolated. In infants, who are at major risk of complications such as sepsis and meningitis, symptoms are ambiguous and fever is not always useful in identifying those at high risk. A diagnosis of acute pyelonephritis is initially made on the basis of urinalysis; dipstick tests for nitrites and/or leukocyte esterase are the most accurate indicators of infection. Collecting a viable urine sample for urine culture using clean voided methods is feasible, even in young children. No gold standard antibiotic treatment exists. In children appearing well, oral therapy and outpatient care is possible. New guidelines suggest less aggressive imaging strategies after a first infection, reducing radiation exposure and costs. The efficacy of antibiotic prophylaxis in preventing recurrence is still a matter of debate and the risk of antibiotic resistance is a warning against its widespread use. Well-performed randomized controlled trials are required in order to better define both the imaging strategies and medical options aimed at preserving long-term renal function.

Keywords

Urinary tract infections Acute pyelonephritis Vesicoureteral reflux Guidelines Antibiotic prophylaxis Antibiotic resistance 

Abbreviations

AAP

American Academy of Pediatrics

AP

Acute pyelonephritis

CKD

Chronic kidney disease

DMSA

Dimercaptosuccinic acid

E. coli

Escherichia coli

fUTI

Febrile urinary tract infections

ISPN

Italian Society of Pediatric Nephrology

LUTI

Lower urinary tract infections

NICE

National Institute for Clinical Excellence

PCT

Procalcitonin

RCT

Randomized controlled trial

SPA

Suprapubic bladder aspiration

TDA

Top-down approach

U-CATH

Urethral catheterization

UPEC

Uropathogenic E. coli

US

Ultrasound

UTI

Urinary tract infections

VCUG

Voiding cystourethrography

VUR

Vesicoureteral reflux

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© IPNA 2015

Authors and Affiliations

  • William Morello
    • 1
  • Claudio La Scola
    • 1
  • Irene Alberici
    • 1
  • Giovanni Montini
    • 2
    Email author
  1. 1.Nephrology and Dialysis Unit, Department of PediatricsAzienda Ospedaliero Universitaria Sant’Orsola-MalpighiBolognaItaly
  2. 2.Pediatric Nephrology and Dialysis Unit, Department of Clinical Sciences and Community HealthUniversity of Milan Fondazione IRCCS Cà Granda -Ospedale Maggiore Policlinico Via della CommendaMilanoItaly

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