Focal bacterial nephritis (lobar nephronia) in children

Klar, Aharon; Hurvitz, Haggit; Berkun, Yaakov; Nadjari, M.; Blinder, George; Israeli, Tomer; Halamish, Ariel; Katz, Amitai; Shazberg, Gila; Branski, David

doi:10.1016/s0022-3476(96)70340-2

Cited by 72 publications

(66 citation statements)

References 14 publications

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“…Furthermore, in these reports, up to one half of these patients with renal abscesses presented with normal urinalyses or negative urine culture results; this implies a different population than my study patients. 19 In a study evaluating ultrasound evidence of focal renal infection in children with presumed pyelonephritis, Klar et al 21 noted focal nephritis in 23 of 210 hospitalized children with UTI, and 25% of those with focal findings developed a renal abscess by computed tomography; the authors noted that abscess formation may be underdiagnosed without such imaging strategies, but the significance of its detection is speculative.…”

Section: Discussionmentioning

confidence: 99%

Nonresponders: Prolonged Fever Among Infants With Urinary Tract Infections

Bachur

2000

Pediatrics

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ABSTRACT. Background. The majority of young children with fever and urinary tract infections (UTIs) have evidence of pyelonephritis based on renal scans. Resolution of fever during treatment is 1 clinical marker of adequate treatment. Theoretically, prolonged fever may be a clue to complications, such as urinary obstruction or renal abscess.Objective. Describe the pattern of fever in febrile children undergoing treatment of a UTI. Compare the clinical characteristics of those patients with prolonged fever to those who respond faster to therapy.Setting. An urban pediatric hospital. Design. Medical record review. Methods. All children <2 years old admitted to the pediatric service with a primary discharge diagnosis of pyelonephritis or UTI were reviewed for 65 consecutive months. Patients with previous UTI, known urologic problems, or immunodeficiency were excluded. Only patients with an admitting temperature >38°C and those who met standard culture criteria were studied. Temperatures are not recorded hourly on the inpatient unit; therefore, they were assigned to blocks of time. Nonresponders were defined as those above the 90th percentile for the time to defervesce. Nonresponders were then compared with the balance of the study patients, termed responders.Results. Of 288 patients studied, the median age was 5.6 months (interquartile range: 1.3-7.9 months old). Median admission temperature was 39.3°C (interquartile range: 38.5°C-40.1°C). Median time to defervesce ranged in the time block 13 to 16 hours. Sixty-eight percent were afebrile by 24 hours and 89% by 48 hours. Thirty-one patients had fever >48 hours (nonresponders). Nonresponders were older than responders ( ABBREVIATIONS. UTI, urinary tract infection; IQR, interquartile range; CI, confidence interval; WBC, white blood cell.

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Section: Discussionmentioning

confidence: 99%

Nonresponders: Prolonged Fever Among Infants With Urinary Tract Infections

Bachur

2000

Pediatrics

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“…In contrast to what has been described for adults, the majority of pediatric cases occur in otherwise healthy children without identifiable risk factors. 5,8,9 S aureus is the most common isolate in cortical abscesses and has been found in 90% of reported cases. 5 This follows because most cortical abscesses result from hematogenous spread.…”

Section: Discussionmentioning

confidence: 99%

Peptostreptococcus asaccharolyticus Renal Abscess: A Rare Cause of Fever of Unknown Origin

2001

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ABSTRACT. Renal abscess is uncommon in pediatrics and is rarely a cause of fever of unknown origin. We recently cared for a patient who presented with a 3-week history of fever. An indium scan ultimately led to the diagnosis of a renal abscess. Aspiration yielded Peptostreptococcus asaccharolyticus. This unusual case prompted a review of the clinical and microbiologic features of renal abscess in pediatric patients at our hospital over the past 10 years. Seven additional patients with a discharge diagnosis of renal abscess were identified. Only 2 of the patients had identifiable risk factors (diabetes mellitus and polycystic kidneys). Staphylococcus aureus or Enterobacteriaceae were responsible for most infections, consistent with hematogenous and urinary tract sources, respectively. No other cases of anaerobic abscess were identified. This case highlights the importance of considering a renal abscess in the differential diagnosis of fever of unknown origin and of processing specimens for both aerobic and anaerobic organisms. ABBREVIATIONS. FUO, fever of unknown origin; MRI, magnetic resonance imaging; CT, computed tomography; CVA, costovertebral angle.

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“…Although renal ultrasonography (US) has been considered as the best and most-effective screening method, various false positive and false negative findings have been reported previously (Rosenfield et al, 1979;Soulen et al, 1989). Computed tomography (CT), instead, has been currently recognized as the most-sensitive and -specific imaging modality for diagnosing ALN (Kline et al, 1988;Soulen et al, 1989;Rathore et al, 1991;Klar et al, 1996;Uehling et al, 2000). CT images of the ALN-infected areas typically appear as wedge-shaped, poorly defined regions of decreased nephrogenic density after contrast medium administration (Figure 2.1) (Kline et al, 1988;Soulen et al, 1989;Rathore et al, 1991;Cheng et al, 2004), and mass-like hypodense lesions in the more-severe form (Lee et al, 1980).…”

Section: Effective Ultrasonographic Predictor For the Diagnosis Of Acmentioning

confidence: 99%

“…Among these UTIs, renal parenchymal infections, including uncomplicated acute pyelonephritis (APN), acute lobar nephronia (ALN), and intrarenal abscess, are considered to be more serious forms of UTI. Acute lobar nephronia (ALN), also known as acute focal bacterial nephritis, is an acute localized bacterial renal infection presenting as an inflammatory mass without liquefaction (Rosenfield et al, 1979;Zaontz et al, 1985;Kline et al, 1988;Klar et al, 1996, Uehling et al, 2000. The typical clinical presentations include fever, flank pain, leukocytosis, pyuria and bacteriuria, similar to presentations of patients with renal abscess or acute pyelonephritis (Zaontz et al, 1985;Soulen et al, 1989).…”

Section: Introductionmentioning

confidence: 99%

“…The management of these renal parenchymal infections differs widely. Most patients with renal abscess require intensive medical therapy with or without surgical intervention, whereas treatment of those with ALN, like uncomplicated APN, entails only intravenous and oral antibiotics (Zaontz et al, 1985;Rathore et al, 1991;Klar et al, 1996). Hence it is important to differentiate these renal parenchymal infections.…”

Section: Introductionmentioning

confidence: 99%

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