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Non‐invasive discrimination of acute focal bacterial nephritis with pyelonephritis
Author(s) -
Oka Hideharu,
Nagamori Tsunehisa,
Yamamoto Shiho,
Manabe Hiromi,
Taketazu Genya,
Mukai Tokuo,
Sakata Hiroshi,
Oki Junichi
Publication year - 2019
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13910
Subject(s) - pyuria , medicine , antimicrobial , gastroenterology , bacteriuria , urinary system , nephritis , urinalysis , microbiology and biotechnology , biology
Background The appropriate antimicrobial treatment period for febrile urinary tract infection ( UTI ) can be changed, depending on whether the patient has acute focal bacterial nephritis ( AFBN ). The aim of this study was to clarify the characteristics of AFBN compared with those of acute pyelonephritis ( APN ) and establish a strategy to detect AFBN . Methods A total of 77 patients diagnosed with febrile UTI were enrolled. They were divided into APN ( n = 64) and AFBN groups ( n = 13). The clinical data and other laboratory biomarkers were retrospectively analyzed. Results The time required for fever resolution after antimicrobial treatment was significantly longer in the AFBN group than in the APN group (2.77 days vs 1.11 days, respectively, P < 0.001). Also, the time to disappearance of pyuria after antimicrobial treatment was longer in the AFBN group than in the APN group (6.22 days vs 2.32 days, respectively, P = 0.001). Fever lasting >1.75 days after antimicrobial treatment had a sensitivity of 92% and specificity of 79% for the detection of AFBN , while pyuria disappearance after 4 days had a sensitivity of 88% and specificity of 85%. When patients fulfilled both cut‐offs, the sensitivity and specificity were 89% and 97%. Conclusion Acute focal bacterial nephritis was associated with fever of significantly longer duration after antimicrobial treatment, and it took a longer time for pyuria to disappear. Children with febrile UTI should be evaluated for AFBN if the fever persists ≥48 h after the initiation of antimicrobial treatment and if pyuria lasts for 4 days.