Acute pyelonephritis in children

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.

Electrolyte and Acid-Base Abnormalities in Infants with Community-Acquired Acute Pyelonephritis: Prospective Cross-Sectional Study

“…In this study, fever and inflammatory markers were used for the diagnosis of pyelonephritis [2,3,15] . In young infants, signs or symptoms such as irritability or lethargy, regurgitation, poor feeding, and failure to thrive were also considered [2,3,15] .…”

“…In infants ≥ 4 weeks to ≤ 24 months of age, presented to the Pediatric Emergency Department of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, the diagnosis of acute pyelonephritis is made according to (1) urinalysis disclosing a pathological pyuria (dipstick) and a positive urine culture ≥ 10 4 colony-forming units of a single pathogen per milliliter from a sample collected through bladder catheterization or ≥ 10 5 from a clean voided specimen (excluding lactobacilli, corynebacteria, and coagulase-negative staphylococci) and (2) axillary temperature ≥ 38.0 ° C or rectal temperature ≥ 38.5 ° C at home or in the emergency department (or, in afebrile infants ≤ 3 months of age, failure to thrive, poor feeding or frequent regurgitation) and at least 2 of either (i) C-reactive protein ≥ 9 mg/L (normal <3 mg/L); (ii) increased total white blood cell count; or (iii) increased neutrophil band-cell count [2,3] .…”

The Course of Pyelonephritis in Children and Adolescents Infected in the Past and Uninfected With Mycobacterium Tuberculosis

“…У пациентов, не инфицированных микобакте-риями туберкулеза, преобладало острое начало пи-елонефрита (или рецидива) с лихорадкой, болевым абдоминальным синдромом, дизурическими явле-ниями, симптомами интоксикации, чаще бакте-риальной лейкоцитурией, что отмечено авторами [5,11,12]. В.А.…”

“…Острым пиелонефритом считали первичный вариант болезни, как правило, заканчивающийся выздоровлением че-рез 1 -6 мес [5,8,10,11]. Хронический пиелонефрит диагностировали при сохранении признаков заболева-ния более 6 мес от его начала или при наличии за этот период не менее двух рецидивов.…”

“…Выясняли перенесенные сома-тические заболевания, частоту и длительность раз-личных инфекционных заболеваний, сопутствующую патологию [5,8,10]. В терапии детей с пиелонефритом применены стандартизованные протоколы антибак-териальной терапии препаратами широкого спектра действия (аугментин, амоксиклав, цефуроксим, цефо-таксим, цефтриаксон) и иммуностимулирующей тера-пии [5,8,[10][11][12].…”