Acute Focal Bacterial Nephritis: Report of Four Cases

Montejo, Miguel; Santiago, Martin Jose; Aguirrebengoa, Koldo; García, Blanca García; Goicoetxea, Josune; Martin, Alex

doi:10.1159/000064465

Cited by 13 publications

(10 citation statements)

References 3 publications

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“…Immune compromising diseases as well as other predisposing factors are associated with the formation of AFBN according to our cohort, such as Diabetes mellitus [1, 8, 9, 13–18], pregnancy [4, 14, 19], urinary tract abnormalities [1, 3, 4, 8–10, 14, 20, 21], prior or concurrent respiratory tract infection [3, 4, 16], former kidney transplantation [7, 22–24], alcohol and drug abuse [2, 25, 26], autoimmune diseases [1, 6, 10] and AIDS [25] (Table 2). Yet it has to be emphasized that AFBN also affects previously healthy immunocompetent patients.…”

Section: Resultsmentioning

confidence: 92%

Acute focal bacterial nephritis is associated with invasive diagnostic procedures - a cohort of 138 cases extracted through a systematic review

et al. 2017

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BackgroundAcute focal bacterial nephritis (AFBN) is a rare disease currently described only in case reports and small case series. In this study we summarize the clinical features of AFBN as has been documented in the literature and draw recommendations on the proper diagnosis and therapy.MethodsA systematic literature review was undertaken in PUBMED, Web of Science and The Cochrane Library online databases for relevant literature on AFBN in adults.ResultsLiterature review revealed a total of 38 articles according to our inclusion criteria, of which we could extract data from 138 cases of AFBN. Fever (98%) and flank pain (80%) were most commonly reported symptoms. E. coli was the most frequent pathogen. Diagnosis was set by CT and/or MRI (52%) with or without sonography or by sonography alone (20%) as well as by sonography combined with IVU. In total, sonography was applied in 83% of cases. All but one patient received antibiotic treatment. Kidney lesions were occasionally mistaken for neoplasms or renal abscesses and as a result, cases were subjected to percutaneous puncture (12.3%), surgical exploration (5.1%) and partial or radical nephrectomy (4.4%). Four cases (2.9%) developed a renal abscess.ConclusionsThe diagnosis of AFBN is set by characteristic clinico-radiological findings. Differential diagnoses of this interstitial bacterial infection include renal abscess and tumor. Correct diagnosis is occasionally impeded by atypical symptoms. Invasive diagnostic and therapeutic procedures should be limited as the majority of cases respond well to conservative treatment.

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Section: Resultsmentioning

confidence: 92%

Acute focal bacterial nephritis is associated with invasive diagnostic procedures - a cohort of 138 cases extracted through a systematic review

et al. 2017

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“…AFBN is a localized bacterial infection without abscess formation. Histopathological examination reveals hyperemia, interstitial edema, and infiltration of leukocytes, but not necrosis or liquefaction [3,4]. As evolution of AFBN into a renal abscess has been described [5,6], it is discussed controversially whether AFBN presents an early stage of renal abscess.…”

Section: Introductionmentioning

confidence: 99%

Acute focal bacterial nephritis in 25 children

et al. 2007

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Acute focal bacterial nephritis (AFBN), formerly known as lobar nephronia, is a rare form of interstitial bacterial nephritis. Most often described in adults with diabetes, there is only limited knowledge of AFBN in children. Ultrasound shows circular hypoechogenic, hypoperfused parenchyma lesions, which may be misdiagnosed as a renal abscess or tumor. From 1984 to 2005, AFBN was diagnosed in 30 children at the University Hospital Münster and the General Hospital Celle, Germany. Data of 25 cases (14 girls, 11 boys) were available for retrospective evaluation. Twenty-five children with AFBN, mean age 4.5 years (range: 0.25-17.5 years), were followed up on average 4.2 years (range: 0.5-11 years). All children were admitted to hospital due to fever and rapid deterioration of clinical condition, initially suspected of having meningitis (four patients), urinary tract infections (five patients), renal tumor (three patients), pneumonia (two patients), appendicitis (one patient), or with only unspecific symptoms (ten patients). AFBN was diagnosed by ultrasound on average 3 days (range: 1-10 days) after onset of symptoms. Pyuria was found in 18/25 children, bacteriuria in 20/25 children, and hematuria in one patient. Blood cultures were negative in all but one patient. Urinary tract abnormalities were found in 12 children, including vesicoureteral reflux (8), megaureter (1), urethral valves (1), unilateral renal hypoplasia (1), and one patient with megacystis, megaureter, caudal dystopic left kidney combined with hypoplasia and dysplasia of the right kidney. High-resolution ultrasound showed AFBN lesions to have resolved completely within 12 weeks after onset of intravenous antibiotic therapy in 20/25 children. Renal parenchymal cysts remained in three cases and focal scarring in two. Blood pressure and renal function was normal in 24/25 cases. AFBN should be suspected in children with fever and rapid deterioration of clinical condition. Residual lesions such as cysts or scarring of renal parenchyma could remain.

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“…A probable reason may be the antibiotic therapy received by the child prior to referral to our hospital. However, negative urine cultures and a lack of leukocyturia in AFBN have been reported previously (6). In the largest study on children with AFBN, 9 out of the 80 (22%) had sterile urine cultures (12).…”

Section: Discussionmentioning

confidence: 85%

“…However, compared to UTI, AFBN is relatively uncommon in children (1,4). Pathologically, there is hyperemia, interstitial edema, and infiltration of leukocytes without necrosis or liquefaction (6). Advances in radiological imaging and an increased awareness of this condition have allowed diagnoses to be made with increasing frequency.…”

Section: Introductionmentioning

confidence: 99%

Acute Focal Bacterial Nephritis Secondary to Vesicoureteric Reflux in a Young Boy

Kumar

Dayal

Gupta

et al. 2015

Arch Pediatr Infect Dis

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Introduction: Acute focal bacterial nephritis (AFBN), previously called acute lobar nephronia, is a rare form of interstitial bacterial nephritis in children. The majority of patients with AFBN have an underlying urinary tract abnormality. Timely initiation of appropriate antimicrobial therapy can prevent abscess formation and help avoid the need for invasive surgical procedures. Case Presentation: Here we describe a case of a 4-year-old boy admitted for a febrile urinary tract infection (UTI). Radiological investigations led to a diagnosis of AFBN. He was later found to also have a pre-existing malformative uropathy. Conclusions: Timely detection and appropriate antibiotic therapy of AFBN are essential to prevent renal abscess formation. A possible diagnosis of AFBN needs to be considered in all patients being treated for febrile UTI. Detection and surgical correction of the underlying malformation are necessary to prevent further recurrences.

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Acute Focal Bacterial Nephritis: Report of Four Cases

Cited by 13 publications

References 3 publications

Acute focal bacterial nephritis is associated with invasive diagnostic procedures - a cohort of 138 cases extracted through a systematic review

Acute focal bacterial nephritis is associated with invasive diagnostic procedures - a cohort of 138 cases extracted through a systematic review

Acute focal bacterial nephritis in 25 children

Acute Focal Bacterial Nephritis Secondary to Vesicoureteric Reflux in a Young Boy

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