Original Article
Is Acute Lobar Nephronia the Midpoint in the Spectrum of Upper Urinary Tract Infections between Acute Pyelonephritis and Renal Abscess?

https://doi.org/10.1016/j.jpeds.2009.07.010Get rights and content

Objective

To examine acute lobar nephronia (ALN) in the spectrum of upper urinary tract infections between acute pyelonephritis (APN) and renal abscess.

Study design

Medical records of 115 patients diagnosed with APN, ALN, or renal abscess with computed tomography (CT) were reviewed retrospectively. CT lesions and patterns of ALN were checked, and the volume of CT lesions was estimated in every patient. Then the correlation between clinical presentation and CT lesions was examined.

Results

The study included 21 patients with APN, 85 with ALN (63 simple ALN, 22 complicated ALN), and 9 with renal abscesses. The volume fraction of CT lesions correlated well with duration of fever before and after treatment in patients with APN or simple ALN, and only the correlation between fever duration after treatment and CT lesions was significant in patients with complicated ALN or renal abscess.

Conclusions

We suggest that simple ALN be regarded clinically as the progression of APN. By contrast, complicated ALN is a distinct, more severe disease entity, and it may relate to or progress to renal abscess. ALN is probably not the midpoint in the traditional dynamic spectrum of upper urinary tract infections between APN and renal abscess.

Section snippets

Methods

This study was approved by our institutional review board, and informed consent was not required. We retrospectively evaluated the medical records of children hospitalized with the discharge diagnosis of UTI at Chang Gang Children's Hospital between January 2006 and December 2007. On the basis of our previously published systematic diagnostic scheme,6 the patients included in this study were those who presented with a febrile UTI who underwent ultrasonographic and CT evaluation to confirm the

Results

In total, 115 patients (21 with APN, 85 with ALN, and 9 with renal abscesses) were included in the study. Of those with APN, 3 had nephromegaly and 18 did not. Only 6 had minimally focal CT lesions similar to simple ALN findings. Of the patients with ALN, 63 had simple ALN (20 right ALN, 23 left ALN, and 20 bilateral ALN), and 22 had complicated ALN (10 right ALN, 8 left ALN, and 4 bilateral ALN). All of the patients with renal abscesses had associated findings of complicated ALN elsewhere in

Discussion

Instead of the characteristic appearance of a focal mass in the kidney with ill-defined margins, the hallmark of the ultrasonographic findings of ALN,3, 10, 11 which unfortunately has a low sensitivity for diagnosis,5, 6, 12 we proposed a systematic imaging evaluation scheme for detecting ALN in patients with febrile UTI. Our scheme combines renal ultrasonography and CT.6 We identified more children with ALN, for an incidence of 8.6% in pediatric patients with febrile UTI.5 Indeed, ALN is not

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The authors declare no conflicts of interest.

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