A 4.5-years Old Girl with Acute Focal Bacterial Nephritis

Czech version

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

Overview

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

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