A 4.5-years Old Girl with Acute Focal Bacterial Nephritis

Česká verzia

Authors: Z. Jančovičová; O. Červeňová; M. Chocholová; A. Černianska; D. Miklovičová; K. Podoláková
Authors place of work: 1. Detská klinika LFUK a DFNsP, Bratislava prednostka doc. MUDr. O. Červeňová, CSc.
Published in the journal: Čes-slov Pediat 2008; 63 (10): 542-546.
Category: Case Report

Summary

Acute focal bacterial nephritis (AFBN) is severe focal infection of kidney parenchyma. The disease is most frequently found in adults but it can be rarely can be diagnosed also in children. Prognosis of the disease is severe, and it often develops into renal abscesses or ends up in renal scaring. A 4.5-years-old girl with vesicoureteral reflux has been followed up by a regional nephrologic outpatient’s department. She has been referred to our clinic by a regional hospital after 3-days long unsuccessful antibiotic therapy of acute pyelonephritis. At the time of admission she had fever 40 °C. Laboratory data showed elevation of inflammatory markers: erythrocyte sedimentation rate (ESR) 108/117, C-reactive proteine (CRP) 490 mg/l, leukocytes 11.5x10⁹/l. Urine analysis showed hematuria, proteinuria, leukocyturia and bacteriuria. Blood culture was sterile. Ultrasonography showed multiple hypodense cortical and subcapsular lesions in both kidneys. Computed tomography confirmed the ultrasonographic findings. Because of anamnestic data of vesicoureteral reflux she was given a permanent catheter. The patient received a combination of intravenous antibacterial and antimycotic therapy during 12 days. The clinical status improved slowly, inflammatory parameters decreased: ESR 60/80, CRP 8.2 mg/l, leukocytes 9.13x10⁹/l, and the temperature dropped to normal. Follow-up kidney ultrasound showed bilateral improvement. Normal glomerular filtration and decreased reabsorption function of kidneys was revealed. The patient is followed up at our pediatric nephrology practice and after half year will be sent for a DMSA scan, which will definitely evaluate the presence of residual changes in kidneys.

Key words:
acute focal bacterial nephritis, pyelonephritis, renal scars, renal ultrasonography

Zdroje

1. Rosenfield AT, Glickman MG, Taylo KJ. Acute focal bacterial nephritis (acute lobar nephronia). Radiology 1979;132: 553–561.

2. Seidel T, Kuwertz-Broking E, Kaczmarek S, et al. Acute focal bacterial nephritis in 25 children. Pediatric Nephrology 2007;22(1)1: 1987–1901.

3. Granados Molina A, Espino Hernández M, Gancedo Baranda A, et al. Acute lobar nephronia: Diagnosis, treatment and prognosis. An. Pediatr. (Barc) 2007;66(1): 84–86.

4. Uehling DT, Hahnfeld LE, Scanlan KA. Urinary tract abnormalities in children with acute focal bacterial nephritis. BJU International 2000;85(7): 885–888.

5. Gut J, Čerbáková H. Hnisavé intrarenální infekce: moderní zobrazovací metody – předpoklad úspěšné konzervativní léčby. Sborník abstrakt 24. pracovní dny dětské nefrologie 2003;57–58.

6. Mihál V, Horák D, Karásková E. Fokální bakteriální nefritida (Acute focal nephronia) imitujíci tumorózní útvar ledviny. Pediatr. Prax. 2006;5: 291–293.

7. Ghalia AM, Mohamed Z, Talaat Y. Case report: A young girl with acute lobar nephronia. Kuwait Medical Journal 2002;34(2): 153–155.

8. Klar A, Hurvitz H, Berkun Y, et al. Focal bacterial nephritis (lobar nephronia) in children. J. Pediatr. 1996;128(6): 850–853.

9. Ehara H, Takeuchi T, Kobayashi K, et al. Acute focal bacterial nephritis (acute lobar nephronia): report of two cases. Nippon Hinyokika Gakkai Zasshi 1989;80(1): 95–99.

10. Šuláková T, Šuláková A, Klodová D, et al. Devastující pyogenní renální onemocnění u dítěte s mnohočetnými trombofilními riziky. Sborník abstrakt 24. pracovní dny dětské nefrologie 2003;57–58.

11. Kong-Sang W, Chun-An Ch. Acute focal bacterial nephritis in an 8-year-old girl. Nephrology (Carlton) 2006;11(3): 238–239.

12. Fernandes RC, Duarte PD. Case report: Perinephric and renal abscesses in children: a study of three cases. Rev. Inst. Med. Trop. Sao Paulo 2002;44(6): 341–344.

13. Aufer J, Grisaru-Soen G, Portnoy O. Bilateral renal abscesses in a healthy child. Isr. Med. Assoc. J. 2002;4(12): 1150–1151.