Diagnosis Of Acute Pyelonephritis Research Articles

Simultaneous segmentation and classification of 99mTc-DMSA renal scintigraphic images with a deep learning approach.

99mTc-DMSA scan plays an important role in assessing functional abnormalities in kidneys. As a promising network for deep learning (DL), Mask R-CNN has the capability of simultaneously segmenting and classifying objects in images. In this study, we tested the feasibility and accuracy of Mask R-CNN in diagnosing acute pyelonephritis (APN) and segmenting kidneys in 99mTc-DMSA scintigraphic images. Two hundred and sixty patients with suspected APN were recruited for DMSA scan, of which 358 kidneys were diagnosed as APN. Of the recruited patients, 210 were randomly selected for training and validating Mask R-CNN, and the other 50 patients' images were used for model testing. Accuracy of the results was assessed by comparing against references from human experts. In the validation phase, the trained model provided segmentation masks with intersection over union (mask IoU, for segmentation accuracy) of 86.6%, and classifications with mean average precision at the bounding box IoU ≥ 50% (mAP50, for classification accuracy) of 86.2%. In testing with the 50 independent patients, mask IoU of the model's segmentation was 90.3%±2.2%, and in classifying the kidneys for APN, the trained model showed accuracy of 89.0%, sensitivity of 84.8% and specificity of 97.0%. In identifying patients with any APN kidney, 3 out of 50 patients were mis-diagnosed, achieving accuracy of 94.0%. Mask R-CNN, designed to perform both segmentation and classification for images, showed much promise in analyzing 99mTc-DMSA images for both accurate diagnosis of APN and kidney segmentation.

Value of Urinary Neutrophil Gelatinase-Associated Lipocalin in Diagnosing Urinary Tract Infections in Children: A Systematic Review and Meta-Analysis.

This study presents a comprehensive review of the literature regarding the use of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a diagnostic tool for urinary tract infection (UTI) in children. Meta-analysis was conducted to evaluate the effectiveness of uNGAL in diagnosing UTI and differentiating acute pyelonephritis (APN) from other sites infection in pediatric patients. We searched PubMed, Web of Science, the Cochrane Library and EMBASE for reports published up to January 2023. We only included published literature that addressed the diagnosis of UTI and APN with the use of uNGAL in children aged 0-18 years. Two authors independently reviewed the included studies and extracted the corresponding data according to the inclusion and exclusion criteria. The sensitivity, specificity and area under the curve for each study were pooled by using a bivariate mixed-effects model. A total of 13 studies met the inclusion criteria for this review: 8 reported on uNGAL diagnosis of UTI, 2 on uNGAL diagnosis of APN, and 3 on both UTI and APN. Among all included studies, uNGAL had good sensitivity (0.88, 95% CI 0.79-0.94) and good specificity (0.86, 95% CI 0.78-0.92) for the diagnosis of UTI. The sensitivity and specificity of uNGAL for the diagnosis of APN were 0.79 (95% CI 0.72-0.85) and 0.78 (95% CI 0.50-0.93), respectively. uNGAL has good sensitivity and specificity in the diagnosis of UTI in children and is a promising marker. However, the use of uNGAL still does not provide significant advantages in the diagnosis of APN in children. Consequently, there is a need to optimize and further explore the assay for improved diagnostic accuracy.

Ultrasound, contrast-enhanced ultrasound and pyelonephritis: A narrative review.

Acute pyelonephritis (APN) is a bacterial infection resulting in kidney inflammation, typically arising as a complication of an ascending urinary tract infection that ascends from the bladder to the kidneys. Clinical diagnosis is generally based on clinical and laboratory findings. Recent guidelines recommend not performing diagnostic imaging unless a complicated APN is suspected or the infection affects high-risk patients such as the elderly, immunocompromised individuals, or diabetics. Contrast-enhanced ultrasound (CEUS) is a valuable tool in both the diagnosis and follow-up of APN. It aids in distinguishing small simple nephritic involvement from abscess complications and monitoring their evolution over time during antibiotic therapy. Given its lack of ionizing radiation and nephrotoxicity, CEUS is a valid diagnostic modality for approaching and monitoring pyelonephritis, improving early identification and characterization of inflammatory lesions. This review aims to summarize the main evidence on the use of ultrasound and CEUS in the diagnosis of APN and its follow-up.

Ultrasound for acute pyelonephritis: a systematic review and meta-analysis.

There is little consensus regarding the indications and utility of urinary tract imaging and type of imaging to perform in patients presenting with acute pyelonephritis (APN). The aims of this systematic review were to, among patients with APN, (i) identify the proportion of patients investigated with ultrasound (US), (ii) identify the proportion of abnormal USand (iii) identify the proportion of patients with a change in management resulting from abnormal US. A comprehensive search covered two electronic databases (Medline and EMBASE), with selection of studies performed independently by two investigators. Inclusion criteria were English language APN diagnosis and quantification of patients assessed with US or abnormal US results. Quality appraisal used the Newcastle-Ottawa instrument. There were 35 studies included. The proportion of patients assessed with US was reported in 16 manuscripts and ranged from 20% to 94%, with significant heterogeneity and publication bias. The proportion of abnormal US was reported in 31 manuscripts and ranged from 7% to 79%. The proportion of abnormal US leading to change in management was reported in five studies and ranged from 7% to 59%. There was marked heterogeneity among studies included in all three subgroups. Patients with APN are commonly investigated with US, but only a small proportion have abnormalities and appear to be associated with changes in clinical management. The use of routine US for APN is therefore questioned. The identification of clinical variables for appropriate selection of patients to investigate with US requires further research.

Added value of non-contrast CT for the diagnosis of acute pyelonephritis in older patients with suspected infection with an unknown focus: a retrospective diagnostic study

ObjectivesIn older patients, the diagnosis of acute pyelonephritis (APN) is challenging. The aim was to evaluate the added value of CT to history, physical examination and urinalysis for the diagnosis...

Acute pyelonephritis in pregnancy and plasma syndecan-1: evidence of glycocalyx involvement

Background Acute pyelonephritis, a risk factor for maternal sepsis, adult respiratory distress syndrome, and preterm labor, is a frequent cause of hospitalization. This condition is characterized by excessive intravascular inflammation and endothelial cell activation and dysfunction. Syndecan-1, a major component of the glycocalyx, is a gel-like layer that covers the luminal surface of healthy endothelial cells, preserving and mediating many endothelial functions. During pregnancy, there is an additional potential source of syndecan-1, the “syncytiotrophoblast glycocalyx,” which lines the intervillous space. Insults that damage the glycocalyx lead to a shedding of syndecan-1 into the circulation. Hence, syndecan-1 has been proposed as a marker of endothelial injury in conditions such as sepsis, trauma, cardiovascular disease, and diabetes mellitus. Objective The objective of this study was to determine whether the plasma syndecan-1 concentration changes in women with acute pyelonephritis in the presence or absence of bacteremia. Study design This cross-sectional study included three groups: (1) non-pregnant women (n = 25); (2) women with an uncomplicated pregnancy from whom samples were collected preterm (n = 61) or at term (n = 69); and (3) pregnant women diagnosed with acute pyelonephritis from whom samples were collected at the time of diagnosis during the second and third trimesters (n = 33). The diagnosis of acute pyelonephritis was based on clinical findings and a positive urine culture for bacteria. Blood culture results were available in 85% (28/33) of women with acute pyelonephritis. Plasma concentrations of syndecan-1 were determined by a validated immunoassay. Results (1) Women with an uncomplicated pregnancy had a higher plasma concentration of syndecan-1 than non-pregnant women. The geometric mean (95% confidence interval [CI]) of syndecan-1 concentration was 51.0 (12.1–216.1) ng/mL in non-pregnant controls; 1280 (365–4487) ng/mL in normal preterm gestations; and 1786 (546–5834) ng/mL in normal term gestations (adjusted p < .005 for all three between group comparisons); (2) plasma syndecan-1 concentrations increased with gestational age among women with a normal pregnancy (p < .001, R 2 = 0.27); (3) syndecan-1 multiple of the mean (MoM) values in pregnant patients with acute pyelonephritis were higher than those in normal pregnant women based on second- and third-trimester samples (p = .048, 1.26-fold change). The increase was driven primarily by cases with a positive blood culture (p = .009, 1.74-fold change); (4) when data from third-trimester samples were compared, overall differences in syndecan-1 MoM values between cases and controls were slightly larger (p = .03, 1.36- fold change), which were especially contributed to by cases with a positive blood culture (p = .023, fold change 1.79-fold change). Conclusions Plasma syndecan-1 concentration is higher in pregnant women and increases as a function of gestational age. Patients with acute pyelonephritis have a higher plasma concentration of syndecan-1, and this is particularly the case in the presence of bacteremia.

The Problem of Occult Pyelonephritis: Acute Pyelonephritis in Patients Presenting Only with Lower Urinary Tract Symptoms

Pyelonephritis is a prevalent diagnosis of emergency department visits. It commonly presents as flank pain and costovertebral tenderness with urinary symptoms. However, some cases occur without typical symptoms. Our study highlights the dubious presentation of pyelonephritis with lower urinary tract symptoms (LUTS) only. This study was conducted at a tertiary care hospital, where charts and files were reviewed from January 11, 2018 to February 28, 2019 for all the patients with a diagnosis of acute pyelonephritis from medical records. In our study, 521 patients were included and 492 (94%) of the participants were suffering from pyelonephritis. Approximately 22.8% of the patients showed the absence of both flank pain and costovertebral tenderness but were diagnosed with pyelonephritis based on computed tomography (CT) and magnetic resonance imaging (MRI). Moreover, 27% of the patients reported upper urinary tract symptoms only and were diagnosed by CT or MRI findings. Out of that only 24% and 16% of the patients reported flank pain and costovertebral tenderness, respectively. Insignificant associations with pyelonephritis were found for age, gender and other comorbidities. Our study showed a significant number of patients with pyelonephritis without any upper urinary tract symptoms. Patients with LUTS should be evaluated further by imaging if they belong to the high-risk population.

Determining the effectiveness of the immature granulocyte percentage and systemic immune-inflammation index in predicting acute pyelonephritis

ABSTRACT Aim The most serious form of urinary tract infection (UTI) is acute pyelonephritis (APN), which can result in bacteremia and renal scarring. This study aims to show the roles that the systemic immune-inflammation index (SII) and the immature granulocyte (IG) percentage play in predicting APN in pediatric patients by comparing them with traditional infection markers. By illustrating a significant relationship between APN, the IG percentage, and the SII, the study’s contributions to the differential diagnosis of UTI can promote a rapid and appropriate treatment of APN. Material and Methods The present study included 522 pediatric patients. The patients were divided into two groups: (I) an APN group (n = 236) and (II) a lower UTI group (n = 286). Results The mean age of the sample was 5.05 ± 4.7 years. According to the most appropriate cutoff values, the findings showed that among all the parameters, C-reactive protein (CRP) and the IG percentage had the highest sensitivities, specificities, and predictive values for predicting APN. Conclusion This study emphasizes the support features of the IG percentage and the SII in the diagnosis of APN in pediatric patients, a topic that has recently attracted attention. The findings indicated that among all of the parameters behind CRP, the IG percentage and the SII had the highest sensitivities, specificities, and predictive values for forecasting APN. It is worth noting that these methods can be applied without additional costs or burdens to the patient.

Renal mucormycosis presenting during the COVID-19 pandemic: A series of 11 cases from a tertiary care center in India.

Introduction:Renal mucormycosis has been documented to occur even in apparently immunocompetent individuals. Owing to the rarity of this disease, literature on its management is small. We present our experience of diagnosing and managing 11 cases of primary renal mucormycosis who presented during the second wave of the COVID-19 pandemic in India.Methods:We reviewed the records of all patients presenting to our institute with a diagnosis of acute pyelonephritis from March 2021 to September 2021. All patients with a radiological, microbiological, or histopathological diagnosis of renal mucormycosis were included in the analysis and all demographic and clinical details, including a history of COVID-19 disease and its treatment, were noted. All patients were treated by a combination of intravenous antifungal therapy and aggressive surgical debridement including nephrectomy and multivisceral resection as required. Predictors of mortality were evaluated by statistical analysis.Results:A total of 93 patients presented to our hospital with features of acute pyelonephritis of which 11 patients were suspected to have primary renal mucormycosis based on characteristic imaging features and confirmed on microbiological and histopathological examination. Of these, four patients had a history of COVID-19 infection. Only one patient had diabetes mellitus. Ten patients underwent nephrectomy and seven needed resections of surrounding organs. The colon was the most commonly involved organ. Five patients (45.5%) died of progressive sepsis. None of the predictors of mortality that were analyzed showed statistical significance.Conclusion:A high index of suspicion, early cross-sectional imaging, prompt institution of antifungal therapy, and aggressive surgical extirpation are very important for achieving good outcomes in patients of primary renal mucormycosis.

Comparing outcomes among outpatients treated for pyelonephritis with oral cephalosporins versus first-line agents

Fluoroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) are first-line agents for acute pyelonephritis. Oral β-lactams are second-line agents owing to reported lower efficacy rates, primarily seen with aminopenicillins rather than cephalosporins. The increase in resistance rates and adverse effects associated with first-line agents provides justification to reconsider oral cephalosporins for pyelonephritis. Therefore, the objective of this study was to determine whether there is a difference in urinary tract infection (UTI) recurrence rates between oral cephalosporins and first-line agents in the treatment of acute pyelonephritis. This was a retrospective, single-centre, observational cohort study from 1 December 2018 to 31 May 2020. The study population was adult TRICARE beneficiaries with a diagnosis of acute pyelonephritis who were treated with oral antibiotics. The two cohorts compared were first-line antibiotics (ciprofloxacin, levofloxacin and TMP-SMX) and oral cephalosporins. The primary outcome was UTI recurrence rate at 30 days, which was defined as a repeat clinic visit, emergency department visit or hospital admission for a UTI (cystitis or pyelonephritis). The secondary outcome was to determine independent risk factors for UTI recurrence. A total of 268 cephalosporin and 211 first-line cases were included. The primary composite outcome of UTI recurrence within 30 days occurred in 44 (16%) cephalosporin and 36 (17%) first-line cases (P=0.851). Independent risk factors for UTI recurrence were chronic kidney disease and Klebsiella spp. isolation. In conclusion, there was no significant difference in UTI recurrence rates between oral cephalosporins and first-line agents in the treatment of acute pyelonephritis in the outpatient setting.

Comparing Interleukin-6, C-Reactive Protein, Erythrocyte Sedimentation Rate, and White Blood Cell Count for the Early Diagnosis of Acute Pyelonephritis in Children

Background: Urinary tract infection (UTI) is common in children. Differentiating lower UTI from acute pyelonephritis (APN) is of great importance in children since early diagnosis and timely management can prevent kidney scarring and associated complications. Objectives: We aimed to compare the diagnostic performance of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count with interleukin-6 (IL-6) for the diagnosis of APN in children. Methods: This cross-sectional study included 38 children with APN (based on clinical findings and positive urine culture) aged 1 month to 15 years admitted to Bandar Abbas Pediatric Hospital, Bandar Abbas, Iran, during 2019-2020. Serum CRP, WBC, IL-6, and WBC count were measured in all children. Age and sex of the participants were also recorded. Results: The mean ± SD age of the children was 65.82±46.67 months, of whom 23 (60.5%) were girls. The sensitivity of WBC, ESR, CRP, and IL-6 for the early diagnosis of APN was 39.5%, 71.1%, 60.5%, and 71.1%, respectively. Taking the results of ESR, CRP, and WBC into account as the basis of diagnosis, altogether 9.98 pg/mL was the best cut-off of serum IL-6 for the diagnosis of APN with 70%-80% sensitivity and 56.5%-73.7% specificity. A significant correlation was found between serum IL-6 and CRP, ESR, and WBC with the strongest correlation between IL-6 and CRP (r=0.451, P=0.004). Age and sex did not affect these correlations. The sensitivity of serum IL-6 at the 5 pg/mL cut-off for the diagnosis of APN was higher in boys and children younger than 6 years. Conclusion: IL-6 can diagnose APN in children aged 1 month to 15 years with 71.1% sensitivity. Its sensitivity is superior to CRP and WBC and comparable with ESR in this regard.

Clinical investigation on acute pyelonephritis without pyuria: a retrospective observational study.

BackgroundThe current guidelines for the diagnosis of acute pyelonephritis (APN) recommend that APN be diagnosed based on the clinical features and the presence of pyuria. However, we observed that some of the patients who are diagnosed with APN do not have characteristic clinical features or pyuria at the initial examination. We performed this study to investigate the characteristics of APN without pyuria.MethodsA retrospective, cross-sectional study was conducted on 391 patients diagnosed with APN based on clinical and radiologic findings, between 2015 and 2019. The clinical features, laboratory results, and computed tomography (CT) findings were compared between patients with normal white blood cell (WBC) counts and those with abnormal WBC counts (WBC of 0–5/high power field [HPF] vs. >5/HPF) in urine. ResultsMore than 50% of patients with APN had no typical urinary tract symptoms and one-third of them had no costovertebral angle (CVA) tenderness. Eighty-eight patients (22.5%) had normal WBC counts (0–5/HPF) on urine microscopy. There was a negative correlation between pyuria (WBC of >5/HPF) and previous antibiotic use (odds ratio, 0.249; 95% confidence interval, 0.140–0.441; p<0.001), and the probability of pyuria was reduced by 75.1% in patients who took antibiotics before visiting the emergency room. ConclusionThe diagnosis of APN should not be overlooked even if there are no typical clinical features, or urine microscopic examination is normal. If a patient has already taken antibiotics at the time of diagnosis, imaging studies such as CT should be performed more actively, regardless of the urinalysis results.

Acute appendicitis coexisting with acute pyelonephritis causing diagnostic dilemma: a case report

BackgroundAcute appendicitis and acute pyelonephritis are the most common diseases admitted to emergency departments. Both conditions have common symptoms such as flank pain, abdominal pain, and fever. Patients’ history, physical examination, laboratory evaluation, and imaging methods are used to differentiate these two conditions. Diverticulitis, colitis, gynecological pathologies, and ureteral stones that mimic acute appendicitis should be kept in mind as differential diagnoses. Cases of pyelonephritis mimicking acute appendicitis have been reported in the literature, but there has not been a reported case in which acute appendicitis occurs during management of acute pyelonephritis. In this article, a case report which can cause such a diagnostic dilemma has been presented.Case presentationA 42-year-old female patient presented with clinical features suggestive of acute appendicitis that developed after a diagnosis of acute pyelonephritis. She underwent laparoscopic appendectomy on account of acute appendicitis during medical treatment for acute pyelonephritis. Physical examination showed only right costovertebral tenderness without any rebound tenderness at McBurney’s point at the first admission, but during treatment rebound tenderness at McBurney’s point was also detected. The Alvarado score of the patient was 5 at the first admission and 7 when acute appendicitis was diagnosed. The patient fully recovered and was discharged after both diseases were completely treated.ConclusionsAs seen in this case, it should be remembered that both diseases can be seen together which causes a diagnostic dilemma. If clinical or biochemical progression is detected in a patient under treatment, imaging methods should be repeated and additional ones with higher resolutions should be used.

New strategy of color and power doppler sonography combined with DMSA in the assessment of acute pyelonephritis in infants

BackgroundThe purpose of this study was to evaluate the clinical value of color and power doppler sonography (CPDS) when combined it with 99mTc-dimercaptosuccinic acid scintigraphy (DMSA) in assessment of acute pyelonephritis (APN) in infants.MethodsA total of 79 children with APN admitted to our hospital from June 2016 to Jan 2019 were enrolled, including 52 boys and 27 girls, age range 1 month to 3 years old. All cases followed the diagnostic criteria for acute pyelonephritis and excluded anatomical abnormalities of urinary system. All 79 patients were examined by urinary ultrasonography (US), CPDS, and DMSA within 48 h of fever and analyzed the clinical value of combining the two methods in the assessment of APN in infants.ResultsAmong 79 children, urinary ultrasonography revealed 2 cases of renal cortical echo changes, both located in the upper pole of the kidney, 24 cases of kidney enlargement, and 1 case of left kidney shrinkage. Ninety-five kidneys were shown to be diseased with DMSA, while 105 kidneys abnormal by CPDS. The sensitivity of CPDS was 69.4%, and the specificity was 38.1%. In children younger than 6 months, the sensitivity of CPDS was 56.9%, which was 84.2% in childeren between 6 months to 1 year, and 94.4% from 1 to 3 years old, respectively. The corresponding specificity of CPDS was 44.1, 26.7, and 35.7%. There was no significant correlation between CPDS levels and DMSA positive results. The abnormal rate of intermediate part in the kidneys was significantly lower than that in the upper and lower poles. Children with abnormal CPDS have a greater risk of renal scarring(p < 0.05).ConclusionAbnormalities detected by CPDS in a cohort of infants with APN poorly correlated with DMSA findings. But the sensitivity of CPDS is highly age-related, it can be used as a non-invasive helpful tool for early diagnosis of acute pyelonephritis in infants older than 6 months old.

Этиология и патогенез острых пиелонефритов у детей

Introduction. Acute pyelonephritis in children takes a leading place among the reasons for hospitalization. Objective. To study the epidemiological, anamnestic, diagnostic and clinical features of the course of pyelonephritis in children. Materials and methods. We have carried out a retrospective study of case histories of 142 children admitted to the urology department of the Emergency hospital №2 (Tomsk) with a diagnosis of acute pyelonephritis. Results. According to the results of our study, children of both sexes of young age (up to 1 year оf age) suffer from acute complicated pyelonephritis, whereas acute uncomplicated pyelonephritis is typical for girls over 3 years old. The sensitivity of ultrasound examination of the kidneys in acute pyelonephritis was 76.8%. The vast majority (96,8%) of acute uncomplicated pyelonephritis were caused by Escherichia coli. Escherichia coli was the cause of acute complicated pyelonephrities only in 30.8% of patients, Pseudomonas aeruginosa was ranked in second in frequency (15.4%), and Enteroccoccus faecalis was ranked third (11.5%). The following antibiotics retained their effectiveness among all the identified causative flora of uncomplicated pyelonephritis: fosfomycin, furagin, gentamicin, amikacin. Only amikacin showed absolute efficiency (100%) in the group of complicated pyelonephritis. 90% of bacteria showed sensitivity to fosfomycin, and 88.5% to cefepime and ertapenem. For children with acute pyelonephritis, the acute phase process of cytomegalovirus, Ebstein-Barr viral infections, previous herpes simplex virus infection, as well as contact with Chlamydia trachomatis, Ureaplasma urealуticum and Mycoplasma hominis are specific. Conclusion. The results of the study indicate the dynamics in the etiology and pathogenesis of acute pyelonephritis in children and a need for an annual monitoring in order to correct therapy.

What is the accuracy of procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) for the diagnosis of acute pyelonephritis in children?

What is the accuracy of procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) for the diagnosis of acute pyelonephritis in children?

Usefulness of computed tomography in the diagnosis of acute pyelonephritis in older patients suspected of infection with unknown focus.

In older adults, the diagnosis of acute pyelonephritis is challenging because of non-specific symptoms and false-positive urine test results. Few studies have investigated the diagnostic performance of computed tomography (CT) signs. To evaluate the diagnostic performance of CT signs for acute pyelonephritis in older patients suspected of infection with unknown focus. This cross-sectional study was conducted between 2015 and 2018. Patients aged ≥65 years who underwent blood cultures, urine culture, and non-contrast or contrast-enhanced CT on admission were included. Cases with clinically presumable infection focus before CT were excluded. Two radiologists blinded to clinical information independently reviewed five CT signs: perirenal fat stranding; pelvicalyceal wall thickening and enhancement; renal enlargement; thickening of Gerota's fascia; and area(s) of decreased attenuation. The final diagnoses were made by a clinical expert panel. Among 473 eligible patients, 61 were diagnosed with acute pyelonephritis. When the laterality of findings between the left and right kidneys were considered, the positive and negative likelihood ratios of perirenal fat stranding were 4.0 (95% confidence interval [CI] = 2.3-7.0) and 0.8 (95% CI = 0.7-0.9) in non-contrast CT, respectively. The other signs in non-contrast CT showed similar diagnostic performance with positive and negative likelihood ratios of 3.5-11.3 and 0.8-0.9, respectively. CT signs can help physicians diagnose acute pyelonephritis in older patients suspected of infection with unknown focus.

Microbiological Spectrum and Outcomes of Acute Pyelonephritis in North Indian Population.

A wide range of causative organisms can cause acute pyelonephritis (APN). However, in recent times, these pathogens have increasingly become resistant to most of the antibiotics making treatment difficult. This was a prospective observational single-center study with a aim to study the microbiological spectrum, resistance patterns, and clinical outcome of patients with APN conducted in a private tertiary care hospital in India. All adult patients hospitalized in the department of nephrology at our institute with a diagnosis of APN from February 2016 to May 2017 were included. Patients <18 years of age, kidney-transplant recipients, and pregnant patients were excluded. Demographic details, clinical symptoms, signs, and radiological and laboratory data including urine and blood cultures of all patients were recorded. The details of treatment received and outcomes in hospital and after discharge were noted. Patients were followed up three months post discharge. Decision of antibiotic and duration of antibiotics was documented by treating nephrologists. Quantitative data were presented in terms of means and standard deviation. Student's "t" test was used for comparison of quantitative outcome parameters. P <0.05 is considered statistically significant. SPSS software version 23.0 was used for statistical analysis. A total of 89 patients with a mean age of 50.33 ± 13.9 years, of which 61.8% were males and were studied; 82/89 had complicated pyelonephritis. The most common risk factor for APN was diabetes mellitus in 64 (72%). Most common symptom was fever in 80 (90%). A triad of fever, flank pain, and dysuria was present only in 27 (30.33%). Overall, 15 patients (16.8%) had severe pyelonephritis requiring intensive care unit admission. The most common organism isolated was Escherichia coli in 26/49 (53%), followed by Klebsiella pneumoniae in 12 (24.40%). Twenty-two (58%) isolates were extended-spectrum beta lactamase producers. Six (12.20%) were resistant to carbapenems and two (4%) were pan-resistant. All 89 were treated with intravenous antibiotics. Older patients, those with diabetes, with poor glycemic control, and with emphysematous pyelonephritis and patients in whom ESBL organisms were grown had poor outcome. Piperacillin tazobactam, aminopenicillins, cefoperazone sulbactam, and carbapenems (in severe pyelonephritis) can be considered as the empirical antibiotic of choice.

The predictability of mean platelet volume as a biomarker of pyelonephritis among pediatrics with urinary tract infection

Introduction: Delayed diagnosis of acute pyelonephritis and its differentiation from cystitis can lead to irreversible complications in renal tissue, hypertension and even renal failure. Objectives: The present study aimed to evaluate the diagnostic value of platelet volume in acute pyelonephritis. Patients and Methods: This cross-sectional study was conducted on 110 children with febrile acute urinary tract infection (UTI) referred to our educational hospital in Qom, Iran. Individuals with inclusion criteria were examined for mean platelet volume (MPV), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) and platelet counts. Additionally, Tc 99m-dimercaptosuccinic acid scan (DMSA scan) was used as the gold standard for differentiation of cystitis from acute pyelonephritis. Urine culture was also used to confirm diagnosis of UTI. Results: The mean age of the participants was two years with a range of two months to 13 years. The MPV (P=0.001), CRP (P=0.001), ESR (P=0.001), platelet (P=0.013) and WBC count (P=0.001) were significantly higher in the pyelonephritis group compared to cystitis group. We showed that MPV has similar potency in differentiating pyelonephritis from cystitis compared to other inflammatory markers; however CRP was more accurate than other markers. The cut-off point for MPV was estimated 7.8 fl, with sensitivity of 91%, specificity of 92.7%, and positive predictive value of 92.6%. Conclusion: The high level of ESR is a risk factor to develop pyelonephritis. MPV as an inflammatory marker is similar to that of other inflammatory markers in segregating pyelonephritis in children, although further studies are needed to confirm the results of this study.

Alteration of Platelet Indices in Young Children with Acute Pyelonephritis

Background Platelets have an important contribution in pathogenesis of different infectious and inflammatory disorders. This study was performed to identify the diagnostic value of platelet count (PLT), and platelet indices in children with acute pyelonephritis (APN). Materials and Methods In a cross sectional case control study, a total of 91 children with APN and 90 healthy control children were investigated during 2018-2019. About 3 ml EDTA blood was drawn before antibiotic treatment and investigated for white blood count (WBC), Hemoglobin level, mean corpuscular volume (MCV), platelet counts, and platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (PLCR) in two groups. Then, the results were compared in two groups. Results Mean age at diagnosis of patients was 34.57±30.96 months. Children with APN had significantly higher PLT, along with lower MPV, PDW and PLCR, compared to the normal healthy group. Using the best cutoff points, PLT>452000, and MPV≤7.7 had the highest sensitivity (96.67%) and specificity (92.22%) for diagnosis of APN, respectively. Based on AUC, PLT and platelet indices were accurate diagnostic markers of APN. Conclusion Based on the results, PLT and platelet indices were fast and additional tests for diagnosis of children with acute febrile urinary tract infection.