Comparative analysis of clinical characters between acute focal bacterial nephritis and acute pylonephritis / 中华肾脏病杂志

ABSTRACT

Objective To improve standards of diagnosis and therapy for acute focal bacterial nephritis bY comparing the characters of acute focal bacterial nephritis and acute pylonephritis.Methods Thirty-five patients of upper urinary tract infection whoever accepted ultrasonographic and computed tomographic (CT) examinations in Beijing Hospital from January 2007 to January 2013 were studied retrospectively.Eighteen patients were diagnosed as acute focal bacterial nephritis (AFBN) according to CT imaging features,the other 17 patients were diagnosed as acute pyelonephritis (non-AFBN).The clinical feature,laboratory and imaging examination were compared between the two groups.Results Leukocyte count,percentage of neutrophil,fasting blood-glucose,ESR,NAG/Cre of urine,the combination of more than one kind of antibiotics and duration of antibiotic treatment were higher or much more in AFBN group patients than non AFBN patients,the differences between two groups were statistical significance(P ＜ 0.05).Urine microorganism culture was mainly Escherichia coli no matter in AFBN group or non-AFBN group,microorganism species of AFBN patients were more complex than non-AFBN patients.The most common contrast-enhanced CT feature of AFBN included local distribution of inflammatory area,wedge-shaped or unregular-shaped hypodense lesions on bilateral or single kidney,and mass-like hypodense lesions in more severe cases.NAG/CRE of urine was higher in AFBN group patients with bilateral kidney lesions than with single kidney lesions and non AFBN patients.The remission time of AFBN and non-AFBN was (3.4 ± 2.9) d,(3.0 ± 1.8)d respectively.The relapsing rate of AFBN and non-AFBN within half a year was 2/18,2/17,respectively.Conclusions The symptoms of acute focal bacterial nephritis are not specific.Abdominal contrast-Enhanced CT,ESR,leukocyte count,urine NAG/CRE are probably a predictor of AFBN.Antibiotic treatment with appropriate usage and sufficient duration could bring satisfactory outcomes and prognosis in acute focal bacterial nephritis and pyelonephritis patients.