medigraphic.com
Organo Oficial de la Sociedad Mexicana de Urología

2020, Number 3

<< Back Next >>

Rev Mex Urol 2020; 80 (3)

Acute bacterial nephritis. A descriptive study of an underdiagnosed entity

Madero-Morales PA, Pallares-Méndez R, Romero-Mata R, Vizcarra-Mata G, Guillén-Lozoya A

Language: English
References: 27
Page: 1-10
PDF size: 202.62 Kb.


ABSTRACT

Background: Acute bacterial nephritis is an infectious process diagnosed through imaging studies. The clinical course of the disease has been shown to be more aggressive than acute pyelonephritis. It continues to be underdiagnosed, thus there are few studies on the entity in the literature.
Objective: To describe the clinical characteristics and imaging features of acute bacterial nephritis, as well as its clinical course.
Design: A descriptive, retrospective case series was conducted.
Materials and methods: Thirty-two cases of acute bacterial nephritis in patients admitted to the hospital within the time frame of 2009 to 2016 were reviewed. The patients’ clinical characteristics upon admission were registered, as well as inpatient clinical progression, culture results, and antibiotic therapy response. The imaging studies were re-evaluated and the diagnostic consistency with either the focal or multifocal disease presentation was confirmed.
Results: Cases predominated in women (n=29, 90.62%) and the most frequently associated comorbidities were diabetes (n=16, 50%) and obesity (n=9, 28.25%). The most important clinical findings upon admission were fever (n=15, 46.87%) and leukocytosis (n=27, 84.38%). Escherichia coli was the most commonly isolated bacterium (63.63%). Both acute focal bacterial nephritis and acute multifocal bacterial nephritis were observed in 46.87% (n=15) and 53.13% (n=17) of the patients, respectively. Imaging studies were required for all diagnoses.
Conclusion: Fever and leukocytosis are the main findings in acute bacterial nephritis. Imaging studies are necessary for making the diagnosis, given that acute pyelonephritis and acute bacterial nephritis cannot be clinically differentiated.


REFERENCES

  1. Rosenfield AT, Glickman MG, Taylor KJ, Crade M, Hodson J. Acute focal bacterial nephritis (acute lobar nephronia). Radiology. 1979;132(3):553–61. doi: 10.1148/132.3.553

  2. Uehling DT, Hahnfeld LE, Scanlan KA. Urinary tract abnormalities in children with acute focal bacterial nephritis. BJU Int. 2000;85(7):885–8. doi: 10.1046/j.1464-410x.2000.00622.x

  3. Cheng C-H, Tsau Y-K, Lin T-Y. Effective duration of antimicrobial therapy for the treatment of acute lobar nephronia. Pediatrics. 2006;117(1):e84-89. doi: 10.1542/peds.2005- 0917

  4. Cano Sch F, Strodthoff R P, Muñoz A O. Nefritis Aguda Focal: Caso Clínico. Revista chilena de pediatría. 2010;81(3):247–52. doi: 10.4067/ S0370-41062010000300008

  5. Sieger N, Kyriazis I, Schaudinn A, Kallidonis P, Dietel A, Ganzer R, et al. Acute Focal Bacterial Nephritis Can Lead to Unnecessary Invasive Procedures: A Report of Three Cases. Urol Int. 2017;99(2):245–8. doi: 10.1159/000441955

  6. Seidel T, Kuwertz-Bröking E, Kaczmarek S, Kirschstein M, Frosch M, Bulla M, et al. Acute focal bacterial nephritis in 25 children. Pediatr Nephrol. 2007;22(11):1897–901. doi: 10.1007/ s00467-007-0589-9

  7. Downs SM. Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Pediatrics. 1999;103(4):e54. doi: 10.1542/peds.103.4.e54

  8. Rathaus V, Werner M. Acute focal nephritis: its true sonographic face. Isr Med Assoc J. 2007;9(10):729–31.

  9. Farmer KD, Gellett LR, Dubbins PA. The sonographic appearance of acute focal pyelonephritis 8 years’ experience. Clin Radiol. 2002;57(6):483–7. doi: 10.1053/ crad.2002.0935

  10. Majd M, Nussbaum Blask AR, Markle BM, Shalaby-Rana E, Pohl HG, Park JS, et al. Acute pyelonephritis: comparison of diagnosis with 99mTc-DMSA, SPECT, spiral CT, MR imaging, and power Doppler US in an experimental pig model. Radiology. 2001;218(1):101–8. doi: 10.1148/radiology.218.1.r01ja37101

  11. Cheng C-H, Tsau Y-K, Hsu S-Y, Lee T-L. Effective ultrasonographic predictor for the diagnosis of acute lobar nephronia. Pediatr Infect Dis J. 2004;23(1):11–4. doi: 10.1097/01. inf.0000105202.57991.3e

  12. Granados Molina A, Espino Hernández M, Gancedo Baranda A, Albillos Merino JC, Álvarez-Cortinas JF, Molina Amores C. Nefronía focal aguda bacteriana: diagnóstico, tratamiento y evolución. An Pediatr 2007;66(1):84–6. doi: 10.1157/13097366

  13. Sugao H, Takiuchi H, Sakurai T. Acute focal bacterial nephritis and renal abscess associated with vesicoureteral reflux. Report of a case. Urol Int. 1988;43(4):253–6. doi: 10.1159/000281349

  14. Dembry L-M, Andriole VT. Renal and perirenal abscesses. Infectious Disease Clinics. 1997;11(3):663–80. doi: 10.1016/S0891- 5520(05)70379-2

  15. Shimizu M, Katayama K, Kato E, Miyayama S, Sugata T, Ohta K. Evolution of acute focal bacterial nephritis into a renal abscess. Pediatr Nephrol. 2005;20(1):93–5. doi: 10.1007/ s00467-004-1646-2

  16. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: Radiologic-Pathologic Review. RadioGraphics. 2008;28(1):255–76. doi: 10.1148/rg.281075171

  17. Garrow JS, Webster J. Quetelet’s index (W/ H2) as a measure of fatness. Int J Obes. 1985;9(2):147–53.

  18. Association AD. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(Supplement 1):S13–27. doi: 10.2337/ dc18-S002

  19. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. doi: 10.1001/ jama.2013.284427

  20. Sieger N, Kyriazis I, Schaudinn A, Kallidonis P, Neuhaus J, Liatsikos EN, et al. Acute focal bacterial nephritis is associated with invasive diagnostic procedures - a cohort of 138 cases extracted through a systematic review. BMC Infect Dis. 2017;17(1):240. doi: 10.1186/ s12879-017-2336-6

  21. Lee JK, McClennan BL, Melson GL, Stanley RJ. Acute focal bacterial nephritis: emphasis on gray scale sonography and computed tomography. AJR Am J Roentgenol. 1980;135(1):87–92. doi: 10.2214/ajr.135.1.87

  22. National Institute for Clinical Excellence. Pyelonephritis (acute): antimicrobial prescribing. England: Public Health England; 2018. 26 p.

  23. Watson JR, Sánchez PJ, Spencer JD, Cohen DM, Hains DS. Urinary Tract Infection and Antimicrobial Stewardship in the Emergency Department. Pediatr Emerg Care. 2018;34(2):93–5. doi: 10.1097/ PEC.0000000000000688

  24. Janett S, Milani GP, Faré PB, Renzi S, Giannini O, Bianchetti MG, et al. Pyuria and microbiology in acute bacterial focal nephritis: a systematic review. Minerva med. 2019;110(3):232–7. doi: 10.23736/S0026-4806.19.06002-6

  25. Bonkat G, Bartoletti RR, Bruyère F, Cai T, Geerlings SE, Köves B, et al. Urological Infections EAU Guidelines on urological infections. European Association of Urology; 2018.

  26. Santacruz A, Collado MC, García-Valdés L, Segura MT, Martín-Lagos JA, Anjos T, et al. Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women. Br J Nutr. 2010;104(1):83– 92. doi: 10.1017/S0007114510000176

  27. Campos-Franco J, Macia C, Huelga E, Diaz- Louzao C, Gude F, Alende R, et al. Acute focal bacterial nephritis in a cohort of hospitalized adult patients with acute pyelonephritis. Assessment of risk factors and a predictive model. Eur J Intern Med. 2017;39:69–74. doi: 10.1016/j.ejim.2016.12.002




2020     |     www.medigraphic.com