Acute Focal Bacterial Nephritis Can Lead to Unnecessary Invasive Procedures: A Report of Three Cases

Rationale:Acute focal bacterial nephritis (AFBN) has mainly been reported in pediatrics. It may be an underdiagnosed condition in adults because it resembles acute pyelonephritis (APN) in its clinical presentation.Presenting concerns of the patients:Two young women (25 and 27 years old, respectively) presented with complaints compatible with a diagnosis of APN. However in both, fever was of high grade, persistent for several days in spite of antibiotic administration, and there was demonstrated worsening of the inflammatory biomarkers. A contrast-enhanced computed tomography (CECT) led to the diagnosis in both cases.Diagnoses:Contrast-enhanced computed tomography reveals the most sensitive and specific images of AFBN. This includes wedge-shaped lesions with decreased enhancement, which may be focal or multifocal.Interventions (including prevention and lifestyle):Antibiotic therapy for at least 3 weeks.Outcomes:Resolution of AFBN was obtained after 3 weeks of antibiotics.Lessons learned:Our 2 cases illustrate the importance of CECT imaging to confirm the diagnosis of AFBN. Interstitial bacterial inflammation may have a worse prognosis if not diagnosed early and efficiently treated. Unlike APN, the management of AFBN requires at least 3 weeks of antibiotics to prevent the development of renal scarring and renal abscess.

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“…(1,3,4) Hematogenous spread appears to be an important infection mechanism for ABN, and wedge-shaped lesions on the renal parenchyma suggest bacterial emboli dissemination. (5) ABN shares the same clinical features as acute pyelonephritis (APN) and both may present with fever, flank pain, pyuria, bacteriuria, and leukocytosis. (3,4,6,7) Therefore, imaging studies are needed to differentiate between ABN and APN.…”

Section: Introductionmentioning

confidence: 99%

Acute bacterial nephritis. A descriptive study of an underdiagnosed entity

Madero-Morales

¹

,

Pallares-Méndez

²

,

Romero-Mata

³

et al. 2020

rmu

0

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Background: Acute bacterial nephritis is an infectious process diagnosed through imaging studies. The clinical course of the disease has been shown to be more aggressive than acute pyelonephritis. It continues to be underdiagnosed, thus there are few studies on the entity in the literature. Objective: To describe the clinical characteristics and imaging features of acute bacterial nephritis, as well as its clinical course. Design: A descriptive, retrospective case series was conducted. Materials and methods: Thirty-two cases of acute bacterial nephritis in patients admitted to the hospital within the time frame of 2009 to 2016 were reviewed. The patients’ clinical characteristics upon admission were registered, as well as inpatient clinical progression, culture results, and antibiotic therapy response. The imaging studies were re-evaluated and the diagnostic consistency with either the focal or multifocal disease presentation was confirmed. Results: Cases predominated in women (n=29, 90.62%) and the most frequently associated comorbidities were diabetes (n=16, 50%) and obesity (n=9, 28.25%). The most important clinical findings upon admission were fever (n=15, 46.87%) and leukocytosis (n=27, 84.38%). Escherichia coli was the most commonly isolated bacterium (63.63%). Both acute focal bacterial nephritis and acute multifocal bacterial nephritis were observed in 46.87% (n=15) and 53.13% (n=17) of the patients, respectively. Imaging studies were required for all diagnoses. Conclusion: Fever and leukocytosis are the main findings in acute bacterial nephritis. Imaging studies are necessary for making the diagnosis, given that acute pyelonephritis and acute bacterial nephritis cannot be clinically differentiated.

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“…(1,3,4) Hematogenous spread appears to be an important infection mechanism for ABN, and wedge-shaped lesions on the renal parenchyma suggest bacterial emboli dissemination. (5) ABN shares the same clinical features as acute pyelonephritis (APN) and both may present with fever, flank pain, pyuria, bacteriuria, and leukocytosis. (3,4,6,7) Therefore, imaging studies are needed to differentiate between ABN and APN.…”

Section: Introductionmentioning

confidence: 99%

Acute bacterial nephritis. A descriptive study of an underdiagnosed entity

Madero-Morales

¹

,

Pallares-Méndez

²

,

Romero-Mata

³

et al. 2020

Rev Mex Urol

0

View full text Add to dashboard Cite

Background: Acute bacterial nephritis is an infectious process diagnosed through imaging studies. The clinical course of the disease has been shown to be more aggressive than acute pyelonephritis. It continues to be underdiagnosed, thus there are few studies on the entity in the literature. Objective: To describe the clinical characteristics and imaging features of acute bacterial nephritis, as well as its clinical course. Design: A descriptive, retrospective case series was conducted. Materials and methods: Thirty-two cases of acute bacterial nephritis in patients admitted to the hospital within the time frame of 2009 to 2016 were reviewed. The patients’ clinical characteristics upon admission were registered, as well as inpatient clinical progression, culture results, and antibiotic therapy response. The imaging studies were re-evaluated and the diagnostic consistency with either the focal or multifocal disease presentation was confirmed. Results: Cases predominated in women (n=29, 90.62%) and the most frequently associated comorbidities were diabetes (n=16, 50%) and obesity (n=9, 28.25%). The most important clinical findings upon admission were fever (n=15, 46.87%) and leukocytosis (n=27, 84.38%). Escherichia coli was the most commonly isolated bacterium (63.63%). Both acute focal bacterial nephritis and acute multifocal bacterial nephritis were observed in 46.87% (n=15) and 53.13% (n=17) of the patients, respectively. Imaging studies were required for all diagnoses. Conclusion: Fever and leukocytosis are the main findings in acute bacterial nephritis. Imaging studies are necessary for making the diagnosis, given that acute pyelonephritis and acute bacterial nephritis cannot be clinically differentiated.

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Acute Focal Bacterial Nephritis Can Lead to Unnecessary Invasive Procedures: A Report of Three Cases

Cited by 9 publications

References 8 publications

Acute Focal Bacterial Nephritis: Two Cases and Review of the Literature

Acute Focal Bacterial Nephritis: Two Cases and Review of the Literature

Acute bacterial nephritis. A descriptive study of an underdiagnosed entity

Acute bacterial nephritis. A descriptive study of an underdiagnosed entity

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