Clinical features of children with acute focal bacterial nephritis / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate the clinical features of acute focal bacterial nephritis (AFBN) in children,and to evaluate the strategy of diagnosis and therapy on children with AFBN,avoiding any blind spots of clinical treatment.Methods The clinical features of 12 cases of AFBN children admitted in Shenzhen Children's Hospital from Jan.2006 to Dec.2012 were analyzed.The clinical features and treatment strategy of AFBN were summarized.ResultsSeven in 12 cases(58.3％) were younger than 1 year old,fever was the initial and cardinal symptom,most cases were lack of typical or local urinary symptoms and signs.Peripheral blood leukoeytes,C-reactive protein and procalcitonin were highly increased in all cases,comparing with simple urinary tract infection.Five cases combined with pyeloureterectasis.One case combined with vesicoureteral reflux (VUR).Blood culturestaphylococcus aureus (1 case),staphylococcus epidermidis (1 case),E.Coli (2 cases).Urine cultureE.Coli (4 cases),E.Coli and enterococcus faecalis (1case),staphylococcus aureus (1 case),white candida yeast (1 case),mixed flora (2 cases).Urinary ultrasoundrenal swelling was showed in involved kidney.Echo of renal parenchyma were enhanced or nonuniform,multiple hypoechoic area were easily visible in involved renal parenchyma,with boundary ambiguity.CT or MRI scantypical findings were reducing perfusion with multiple wedge-shaped or quasi-circular lesions.Broad-spectrum antibacterial treatment was effective and necessary.The medication of antimicrobial was under the guidance of drug susceptibility test.The average course of treatment was 14-55 days.Eleven cases were cured by conservative treatment.Conclusions The morbility of AFBN in young infants are high.The combination of urinary tract deformity,pyeloureterectasis or VUR should be highly vigilant in AFBN children.Imageological inspection of urinary tract is the necessary method on AFBN diagnosis.The major pathogen is E.Coli,which shows a high resistance to antibiotics.Conservative antibacterial treatment is effective in AFBN.