Bookmarks
KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Synonyms
- Acute lobar nephronia, focal bacterial nephritis
Definitions
- Acute infection of renal parenchyma
- Overview
- Classic imaging appearance: Focal swelling & ↓ perfusion of affected parenchyma visible on nuclear scintigraphy, US, CT, & MR
- Associated vesicoureteral reflux (VUR) in ~ 1/3 of cases
- Permanent scarring is more likely in children < 2 years old
- Variable presentation: Fever, lethargy, irritability, vomiting, abdominal/flank pain, hematuria, or dysuria
- Imaging work-up of urinary tract infection (UTI) is controversial; professional society guidelines vary internationally
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- 't Hoen LA et al: Update of the EAU/ESPU guidelines on urinary tract infections in children. J Pediatr Urol. 17(2):200-7, 2021
- Buettcher M et al: Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr. 180(3):663-74, 2020
- Freesmeyer M et al: Real-time DMSA-SPECT/US fusion imaging revealing nonscarring loss of function after pyelonephritis. Clin Nucl Med. 45(6):e274-5, 2020
- Lee YJ et al: Relationship between breastfeeding, birth history, and acute pyelonephritis in infants. J Korean Med Sci. 35(8):e32, 2020
- Pleniceanu O et al: Acute pyelonephritis in children and the risk of end-stage kidney disease. J Nephrol. ePub, 2020
- Simrén Y et al: Diffusion weighted imaging is a promising method to detect acute pyelonephritis in non-sedated free breathing infants. J Pediatr Urol. 16(3):320-5, 2020
- Sjöström S et al: Bladder/bowel dysfunction in pre-school children following febrile urinary tract infection in infancy. Pediatr Nephrol.36(6):1489-97, 2020
- Warner J et al: Unenhanced MRI of the abdomen and pelvis in the comprehensive evaluation of acute atraumatic abdominal pain in children. AJR Am J Roentgenol. 215(5):1218-28, 2020
- Zhu H et al: Semiquantitative analysis of power doppler ultrasonography versus Tc-99m DMSA scintigraphy in diagnostic and severity assessment of acute childhood pyelonephritis. Transl Pediatr. 9(4):487-95, 2020
- Bahat H et al: Predictors of grade 3-5 vesicoureteral reflux in infants ≤2 months of age with pyelonephritis. Pediatr Nephrol. 34(5):907-15, 2019
- Kosmeri C et al: An update on renal scarring after urinary tract infection in children: what are the risk factors? J Pediatr Urol. 15(6):598-603, 2019
- Millner R et al: Urinary tract infections. Pediatr Clin North Am. 66(1):1-13, 2019
- Shaikh N et al: Host and bacterial markers that differ in children with cystitis and pyelonephritis. J Pediatr. 209:146-53.e1, 2019
- Bosakova A et al: Diffusion-weighted magnetic resonance imaging is more sensitive than dimercaptosuccinic acid scintigraphy in detecting parenchymal lesions in children with acute pyelonephritis: a prospective study. J Pediatr Urol. 14(3):269.e1-7, 2018
- Lee JW et al: D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection. Pediatr Nephrol. 33(4):631-7, 2018
- Palmer LS et al: Cost-effectiveness of antimicrobial prophylaxis for children in the RIVUR trial. World J Urol. 36(9):1441-7, 2018
- Chung EM et al: Imaging of the pediatric urinary system. Radiol Clin North Am. 55(2):337-57, 2017
- Expert Panel on Pediatric Imaging:. et al: ACR Appropriateness Criteria® Urinary Tract Infection-Child. J Am Coll Radiol. 14(5S):S362-71, 2017
- Mattoo TK et al: Interobserver variability for interpretation of DMSA scans in the RIVUR trial. J Pediatr Urol. 13(6):616.e1-6, 2017
- Arlen AM et al: Computer model predicting breakthrough febrile urinary tract infection in children with primary vesicoureteral reflux. J Pediatr Urol. 12(5):288.e1-5, 2016
- Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis & Management of the Initial Urinary Tract Infection in Febrile Infants & Young Children 2–24 Months of Age. American Academy of Pediatrics. Published December, 2016. Accessed March 2021. https://pediatrics.aappublications.org/content/138/6/e20163026
- Zhang GQ et al: The effect of vitamin A on renal damage following acute pyelonephritis in children: a meta-analysis of randomized controlled trials. Pediatr Nephrol. 31(3):373-9, 2016
- de Bessa J Jr et al: Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux. J Urol. 193(5 Suppl):1772-7, 2015
- Morello W et al: Acute pyelonephritis in children. Pediatr Nephrol. 31(8):1253-65, 2015
- Narchi H et al: Renal tract abnormalities missed in a historical cohort of young children with UTI if the NICE and AAP imaging guidelines were applied. J Pediatr Urol. 11(5):252.e1-7, 2015
- Shaikh N et al: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev. 1:CD009185, 2015
- Sood A et al: Incidence, admission rates, and economic burden of pediatric emergency department visits for urinary tract infection: data from the nationwide emergency department sample, 2006 to 2011. J Pediatr Urol. 11(5):246.e1-8, 2015
- Cerwinka WH et al: Comparison of magnetic resonance urography to dimercaptosuccinic acid scan for the identification of renal parenchyma defects in children with vesicoureteral reflux. J Pediatr Urol. 10(2):344-51, 2014
- Jacobson D et al: Perinephric abscesses in the pediatric population: case presentation and review of the literature. Pediatr Nephrol. 29(5):919-25, 2014
- Strohmeier Y et al: Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 7:CD003772, 2014
- Yang TH et al: Obesity and a febrile urinary tract infection: dual burden for young children? Urology. 84(2):445-9, 2014
- La Scola C et al: Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics. 131(3):e665-71, 2013
- Leroy S et al: Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics. 131(5):870-9, 2013
- Shaikh N et al: Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 126(6):1084-91, 2010
- Brenner M et al: Comparison of 99mTc-DMSA dual-head SPECT versus high-resolution parallel-hole planar imaging for the detection of renal cortical defects. AJR Am J Roentgenol. 193(2):333-7, 2009
- Siomou E et al: Implications of 99mTc-DMSA scintigraphy performed during urinary tract infection in neonates. Pediatrics. 124(3):881-7, 2009
- Cerwinka WH et al: Magnetic resonance urography in pediatric urology. J Pediatr Urol. 4(1):74-82; quiz 82-3, 2008
- Urinary tract infection in children: diagnosis, treatment & long-term management. National Collaborating Centre for Women's & Children's Health. Commissioned by the National Institute for Health & Clinical Excellence. Published August 2007. Updated 2017. Accessed March 2021. https://www.nice.org.uk/guidance/cg54/evidence/full-guideline-pdf-196566877
- Gonzalez E et al: Impact of vesicoureteral reflux on the size of renal lesions after an episode of acute pyelonephritis. J Urol. 173(2):571-4; discussion 574-5, 2005
- Wang YT et al: Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol. 173(1):190-4; discussion 194, 2005
- Hoberman A et al: Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 348(3):195-202, 2003
- Maturen KE et al: Computed tomographic diagnosis of unsuspected pyelonephritis in children. Can Assoc Radiol J. 53(5):279-83, 2002
- Kraus SJ: Genitourinary imaging in children. Pediatr Clin North Am. 48(6):1381-424, 2001
- Majd M et al: Acute pyelonephritis: comparison of diagnosis with 99mTc-DMSA, SPECT, spiral CT, MR imaging, and power Doppler US in an experimental pig model. Radiology. 218(1):101-8, 2001
- Roberts KB: A synopsis of the American Academy of Pediatrics' practice parameter on the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr Rev. 20(10):344-7, 1999
- Yen TC et al: Identification of new renal scarring in repeated episodes of acute pyelonephritis using Tc-99m DMSA renal SPECT. Clin Nucl Med. 23(12):828-31, 1998
- Winters WD: Power Doppler sonographic evaluation of acute pyelonephritis in children. J Ultrasound Med. 15(2):91-6; quiz 97-8, 1996
- AAP Gateway: Urinary tract infection: clinical practice guideline for the diagnosis & management of the initial UTI in febrile infants & children 2 to 24 months. Published August, 2011. Accessed May 2016. http://pediatrics.aappublications.org/content/early/2011/08/24/peds.2011-1330
- NICE: NICE guidelines. Published August 2007. Accessed May 2016. https://www.nice.org.uk/guidance/cg54
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Synonyms
- Acute lobar nephronia, focal bacterial nephritis
Definitions
- Acute infection of renal parenchyma
- Overview
- Classic imaging appearance: Focal swelling & ↓ perfusion of affected parenchyma visible on nuclear scintigraphy, US, CT, & MR
- Associated vesicoureteral reflux (VUR) in ~ 1/3 of cases
- Permanent scarring is more likely in children < 2 years old
- Variable presentation: Fever, lethargy, irritability, vomiting, abdominal/flank pain, hematuria, or dysuria
- Imaging work-up of urinary tract infection (UTI) is controversial; professional society guidelines vary internationally
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- 't Hoen LA et al: Update of the EAU/ESPU guidelines on urinary tract infections in children. J Pediatr Urol. 17(2):200-7, 2021
- Buettcher M et al: Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr. 180(3):663-74, 2020
- Freesmeyer M et al: Real-time DMSA-SPECT/US fusion imaging revealing nonscarring loss of function after pyelonephritis. Clin Nucl Med. 45(6):e274-5, 2020
- Lee YJ et al: Relationship between breastfeeding, birth history, and acute pyelonephritis in infants. J Korean Med Sci. 35(8):e32, 2020
- Pleniceanu O et al: Acute pyelonephritis in children and the risk of end-stage kidney disease. J Nephrol. ePub, 2020
- Simrén Y et al: Diffusion weighted imaging is a promising method to detect acute pyelonephritis in non-sedated free breathing infants. J Pediatr Urol. 16(3):320-5, 2020
- Sjöström S et al: Bladder/bowel dysfunction in pre-school children following febrile urinary tract infection in infancy. Pediatr Nephrol.36(6):1489-97, 2020
- Warner J et al: Unenhanced MRI of the abdomen and pelvis in the comprehensive evaluation of acute atraumatic abdominal pain in children. AJR Am J Roentgenol. 215(5):1218-28, 2020
- Zhu H et al: Semiquantitative analysis of power doppler ultrasonography versus Tc-99m DMSA scintigraphy in diagnostic and severity assessment of acute childhood pyelonephritis. Transl Pediatr. 9(4):487-95, 2020
- Bahat H et al: Predictors of grade 3-5 vesicoureteral reflux in infants ≤2 months of age with pyelonephritis. Pediatr Nephrol. 34(5):907-15, 2019
- Kosmeri C et al: An update on renal scarring after urinary tract infection in children: what are the risk factors? J Pediatr Urol. 15(6):598-603, 2019
- Millner R et al: Urinary tract infections. Pediatr Clin North Am. 66(1):1-13, 2019
- Shaikh N et al: Host and bacterial markers that differ in children with cystitis and pyelonephritis. J Pediatr. 209:146-53.e1, 2019
- Bosakova A et al: Diffusion-weighted magnetic resonance imaging is more sensitive than dimercaptosuccinic acid scintigraphy in detecting parenchymal lesions in children with acute pyelonephritis: a prospective study. J Pediatr Urol. 14(3):269.e1-7, 2018
- Lee JW et al: D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection. Pediatr Nephrol. 33(4):631-7, 2018
- Palmer LS et al: Cost-effectiveness of antimicrobial prophylaxis for children in the RIVUR trial. World J Urol. 36(9):1441-7, 2018
- Chung EM et al: Imaging of the pediatric urinary system. Radiol Clin North Am. 55(2):337-57, 2017
- Expert Panel on Pediatric Imaging:. et al: ACR Appropriateness Criteria® Urinary Tract Infection-Child. J Am Coll Radiol. 14(5S):S362-71, 2017
- Mattoo TK et al: Interobserver variability for interpretation of DMSA scans in the RIVUR trial. J Pediatr Urol. 13(6):616.e1-6, 2017
- Arlen AM et al: Computer model predicting breakthrough febrile urinary tract infection in children with primary vesicoureteral reflux. J Pediatr Urol. 12(5):288.e1-5, 2016
- Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis & Management of the Initial Urinary Tract Infection in Febrile Infants & Young Children 2–24 Months of Age. American Academy of Pediatrics. Published December, 2016. Accessed March 2021. https://pediatrics.aappublications.org/content/138/6/e20163026
- Zhang GQ et al: The effect of vitamin A on renal damage following acute pyelonephritis in children: a meta-analysis of randomized controlled trials. Pediatr Nephrol. 31(3):373-9, 2016
- de Bessa J Jr et al: Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux. J Urol. 193(5 Suppl):1772-7, 2015
- Morello W et al: Acute pyelonephritis in children. Pediatr Nephrol. 31(8):1253-65, 2015
- Narchi H et al: Renal tract abnormalities missed in a historical cohort of young children with UTI if the NICE and AAP imaging guidelines were applied. J Pediatr Urol. 11(5):252.e1-7, 2015
- Shaikh N et al: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev. 1:CD009185, 2015
- Sood A et al: Incidence, admission rates, and economic burden of pediatric emergency department visits for urinary tract infection: data from the nationwide emergency department sample, 2006 to 2011. J Pediatr Urol. 11(5):246.e1-8, 2015
- Cerwinka WH et al: Comparison of magnetic resonance urography to dimercaptosuccinic acid scan for the identification of renal parenchyma defects in children with vesicoureteral reflux. J Pediatr Urol. 10(2):344-51, 2014
- Jacobson D et al: Perinephric abscesses in the pediatric population: case presentation and review of the literature. Pediatr Nephrol. 29(5):919-25, 2014
- Strohmeier Y et al: Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 7:CD003772, 2014
- Yang TH et al: Obesity and a febrile urinary tract infection: dual burden for young children? Urology. 84(2):445-9, 2014
- La Scola C et al: Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics. 131(3):e665-71, 2013
- Leroy S et al: Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics. 131(5):870-9, 2013
- Shaikh N et al: Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 126(6):1084-91, 2010
- Brenner M et al: Comparison of 99mTc-DMSA dual-head SPECT versus high-resolution parallel-hole planar imaging for the detection of renal cortical defects. AJR Am J Roentgenol. 193(2):333-7, 2009
- Siomou E et al: Implications of 99mTc-DMSA scintigraphy performed during urinary tract infection in neonates. Pediatrics. 124(3):881-7, 2009
- Cerwinka WH et al: Magnetic resonance urography in pediatric urology. J Pediatr Urol. 4(1):74-82; quiz 82-3, 2008
- Urinary tract infection in children: diagnosis, treatment & long-term management. National Collaborating Centre for Women's & Children's Health. Commissioned by the National Institute for Health & Clinical Excellence. Published August 2007. Updated 2017. Accessed March 2021. https://www.nice.org.uk/guidance/cg54/evidence/full-guideline-pdf-196566877
- Gonzalez E et al: Impact of vesicoureteral reflux on the size of renal lesions after an episode of acute pyelonephritis. J Urol. 173(2):571-4; discussion 574-5, 2005
- Wang YT et al: Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol. 173(1):190-4; discussion 194, 2005
- Hoberman A et al: Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 348(3):195-202, 2003
- Maturen KE et al: Computed tomographic diagnosis of unsuspected pyelonephritis in children. Can Assoc Radiol J. 53(5):279-83, 2002
- Kraus SJ: Genitourinary imaging in children. Pediatr Clin North Am. 48(6):1381-424, 2001
- Majd M et al: Acute pyelonephritis: comparison of diagnosis with 99mTc-DMSA, SPECT, spiral CT, MR imaging, and power Doppler US in an experimental pig model. Radiology. 218(1):101-8, 2001
- Roberts KB: A synopsis of the American Academy of Pediatrics' practice parameter on the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr Rev. 20(10):344-7, 1999
- Yen TC et al: Identification of new renal scarring in repeated episodes of acute pyelonephritis using Tc-99m DMSA renal SPECT. Clin Nucl Med. 23(12):828-31, 1998
- Winters WD: Power Doppler sonographic evaluation of acute pyelonephritis in children. J Ultrasound Med. 15(2):91-6; quiz 97-8, 1996
- AAP Gateway: Urinary tract infection: clinical practice guideline for the diagnosis & management of the initial UTI in febrile infants & children 2 to 24 months. Published August, 2011. Accessed May 2016. http://pediatrics.aappublications.org/content/early/2011/08/24/peds.2011-1330
- NICE: NICE guidelines. Published August 2007. Accessed May 2016. https://www.nice.org.uk/guidance/cg54
