Could Renal Abscess Be a Complication of Pyelonephritis in this Patient?

Discussion Urinary tract infections (UTI) are common. By the age of 7 years up to 8% of girls and 2% of boys have had a UTI. The current American Academy of Pediatrics criteria for a UTI diagnosis includes presence of pyruria (determined by microscopy) or leucocyte esterase (on dipstick) AND a culture-positive urine of < 50,000 colony-forming units/mL on a catheterized specimen, or >100,000 colony-forming units on a voided specimen. Because of possible contamination, bagged specimens are not acceptable. Clinical pyelonephritis (ie febrile UTI) is a fairly common problem in the pediatric population. Learning Point Renal abscesses are uncommon with the exact incidence unknown and are defined as collections of purulent material within or adjacent to the kidney itself. The two most common bacteria are Escherichia coli (assumed to be due to ascending UTI) and Staphylococcus aureus (associated with hematogeneous spread). Patients with renal abscesses may present with clinical pyelonephritis symptoms such as fever, nausea, weight loss, dysuria, malodorous urine, abdominal or flank pain. Renal abscess should be considered when there is prolonged fever without a source and when response to treatment of clinical pyelonephritis is prolonged. Renal ultrasound is a good imaging modality for renal abscess but computed tomography may be needed to differentiate abscess from renal changes associated with pyelonephritis itself. Overall 20-90% of children with acute pyelonephritis have some ac...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news