Abstract
BackgroundUpper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy.ObjectiveA set of clinical symptoms, laboratory markers, and ultrasound findings were assessed to achieve the early diagnosis and prognosis of pyelonephritis in hospitalized pediatrics.MethodsA cross-sectional study with 104 Iranian children (95 girls and 9 boys) aged 1 month to 12 years with acute pyelonephritis during 2012–2018 was conducted. The ultrasound examination of kidneys and urinary tract during hospitalization, the incidence of clinical symptoms, and laboratory markers in blood and urine were monitored to identify the best predictive factors of early diagnosis of this bacterial infection.ResultsThree-fourth of the patients had one of the four clinical symptoms of abdominal pain, constipation, dysuria, and vomiting, while others were asymptomatic. A much frequency of pyuria (88.46%), Escherichia coli in urine (92.31%), leukocytosis (81.73%), and high ESR (> 10 mm/h, 92.30%) and CRP (> 10 mg/L, 82.82%) was observed. The kidney and urinary tract ultrasonography only in 32.7% of children revealed findings in favor of pyelonephritis (cystitis, ureteral stones, and hydronephrosis).ConclusionThere was a high frequency of clinical signs and laboratory markers associated with pyelonephritis. Ultrasound alone was not an efficient tool to track febrile UTI as most patients presented normal sonography.
Highlights
Upper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy
Since renal scarring is observed in 37% of acute pyelonephritis (AP) children after two years from the infection onset, the rapid diagnosis and implementation of effective therapeutic measures are necessary to manage this disease among children [4, 11,12,13]
Study design and participants A cross-sectional study was designed to evaluate laboratory signs, clinical symptoms, and ultrasonography examinations obtained from 104 children with AP who were hospitalized in Bahrami Hospital (Tehran, Iran) from 2012 to 2018
Summary
Upper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy. It has been reported that the annual cost of treating this disease in France and the US was about €58 million and $2.47 billion, respectively [2, 3]. In childhood, this disease usually occurs in boy infants due to congenital anomalies of kidneys and urinary tract, while AP is observed in girls at older ages [4,5,6]. Escherichia coli is the main responsible pathogen for AP This pathogen often causes severe inflammation and short-term (e.g., fever, dysuria, and flank pain) and long-term (e.g., irreversible renal scarring) morbidities [7, 8]. Since renal scarring is observed in 37% of AP children after two years from the infection onset, the rapid diagnosis and implementation of effective therapeutic measures are necessary to manage this disease among children [4, 11,12,13]
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