Acute lobar nephronia often has misleading presentation

 

MADRID – Acute lobar nephronia needs to be considered in children with high fever, abdominal pain, and markedly elevated acute-phase reactants, even if their urinalysis and ultrasound results are negative, Paula Sanchez-Marcos, MD, reported at the annual meeting of the European Society for Paediatric Infectious Diseases.

Zoonar RF/Thinkstock

Additional imaging with CT or MRI often is required to make the diagnosis of this severe localized infection of renal parenchyma, an infection that sometimes progresses to renal abscesses and scarring, according to Dr. Sanchez-Marcos of Virgen del Rocio Hospital in Seville, Spain.

She presented a retrospective study of 18 episodes of acute lobar nephronia (ALN) in 16 children seen at the hospital, a tertiary referral center. Six of the children had vesicoureteral reflux or another underlying uropathy. Mean age at diagnosis was 79 months, with a range of 5 to 180 months.

All patients had a fever greater than 38.5° C when they presented with a mean 6-day history of illness. Of the 16 children, 14 had abdominal pain. The mean C-reactive protein level was 197 mg/L, with a WBC count of 21,962 cells/mcL and a neutrophil count of 17,372 cells/mcL.

Urine dipstick was negative in five episodes. However, urine culture was eventually productive in 10 episodes, with Escherichia coli the most commonly isolated microorganism, found in five of these cases.

All patients underwent ultrasound imaging a mean of 1.7 days into their hospital admission, although it established the diagnosis of ALN in only two episodes. Additional imaging with CT had a 91% sensitivity, showing positive results in 10 of 11 cases, while MRI had 100% sensitivity.

Patients received IV antibiotics for a median of 14 days before switching to sequential oral antibiotics for a median of 8.7 days.

Three patients developed renal abscesses, with percutaneous drainage required in two instances. Unilateral renal scarring occurred in 7 of 16 patients.

Dr. Sanchez-Marcos recommended technetium-99m dimercaptosuccinic acid renal scintigraphy as a tool to confirm improvement in response to antimicrobial therapy.

She reported having no financial conflicts regarding her presentation.

[email protected]
 

 

MADRID – Acute lobar nephronia needs to be considered in children with high fever, abdominal pain, and markedly elevated acute-phase reactants, even if their urinalysis and ultrasound results are negative, Paula Sanchez-Marcos, MD, reported at the annual meeting of the European Society for Paediatric Infectious Diseases.

Zoonar RF/Thinkstock

Additional imaging with CT or MRI often is required to make the diagnosis of this severe localized infection of renal parenchyma, an infection that sometimes progresses to renal abscesses and scarring, according to Dr. Sanchez-Marcos of Virgen del Rocio Hospital in Seville, Spain.

She presented a retrospective study of 18 episodes of acute lobar nephronia (ALN) in 16 children seen at the hospital, a tertiary referral center. Six of the children had vesicoureteral reflux or another underlying uropathy. Mean age at diagnosis was 79 months, with a range of 5 to 180 months.

All patients had a fever greater than 38.5° C when they presented with a mean 6-day history of illness. Of the 16 children, 14 had abdominal pain. The mean C-reactive protein level was 197 mg/L, with a WBC count of 21,962 cells/mcL and a neutrophil count of 17,372 cells/mcL.

Urine dipstick was negative in five episodes. However, urine culture was eventually productive in 10 episodes, with Escherichia coli the most commonly isolated microorganism, found in five of these cases.

All patients underwent ultrasound imaging a mean of 1.7 days into their hospital admission, although it established the diagnosis of ALN in only two episodes. Additional imaging with CT had a 91% sensitivity, showing positive results in 10 of 11 cases, while MRI had 100% sensitivity.

Patients received IV antibiotics for a median of 14 days before switching to sequential oral antibiotics for a median of 8.7 days.

Three patients developed renal abscesses, with percutaneous drainage required in two instances. Unilateral renal scarring occurred in 7 of 16 patients.

Dr. Sanchez-Marcos recommended technetium-99m dimercaptosuccinic acid renal scintigraphy as a tool to confirm improvement in response to antimicrobial therapy.

She reported having no financial conflicts regarding her presentation.

[email protected]
 

 

MADRID – Acute lobar nephronia needs to be considered in children with high fever, abdominal pain, and markedly elevated acute-phase reactants, even if their urinalysis and ultrasound results are negative, Paula Sanchez-Marcos, MD, reported at the annual meeting of the European Society for Paediatric Infectious Diseases.

Zoonar RF/Thinkstock

Additional imaging with CT or MRI often is required to make the diagnosis of this severe localized infection of renal parenchyma, an infection that sometimes progresses to renal abscesses and scarring, according to Dr. Sanchez-Marcos of Virgen del Rocio Hospital in Seville, Spain.

She presented a retrospective study of 18 episodes of acute lobar nephronia (ALN) in 16 children seen at the hospital, a tertiary referral center. Six of the children had vesicoureteral reflux or another underlying uropathy. Mean age at diagnosis was 79 months, with a range of 5 to 180 months.

All patients had a fever greater than 38.5° C when they presented with a mean 6-day history of illness. Of the 16 children, 14 had abdominal pain. The mean C-reactive protein level was 197 mg/L, with a WBC count of 21,962 cells/mcL and a neutrophil count of 17,372 cells/mcL.

Urine dipstick was negative in five episodes. However, urine culture was eventually productive in 10 episodes, with Escherichia coli the most commonly isolated microorganism, found in five of these cases.

All patients underwent ultrasound imaging a mean of 1.7 days into their hospital admission, although it established the diagnosis of ALN in only two episodes. Additional imaging with CT had a 91% sensitivity, showing positive results in 10 of 11 cases, while MRI had 100% sensitivity.

Patients received IV antibiotics for a median of 14 days before switching to sequential oral antibiotics for a median of 8.7 days.

Three patients developed renal abscesses, with percutaneous drainage required in two instances. Unilateral renal scarring occurred in 7 of 16 patients.

Dr. Sanchez-Marcos recommended technetium-99m dimercaptosuccinic acid renal scintigraphy as a tool to confirm improvement in response to antimicrobial therapy.

She reported having no financial conflicts regarding her presentation.

[email protected]