Acute focal bacterial nephritis in a cohort of hospitalized adult patients with acute pyelonephritis. Assessment of risk factors and a predictive model

Published:December 13, 2016DOI:https://doi.org/10.1016/j.ejim.2016.12.002

      Highlights

      • Acute focal bacterial nephritis (AFBN) is probably underdiagnosed and is not rare in adults.
      • Use of contraceptives was a frequent finding, but many patients have no previous risk factors.
      • Atypical clinical manifestations were more frequent in patients with AFBN.
      • In such cases, CT can avoid unnecessary procedures.
      • Clinical outcome under medical therapy is generally good in patients with AFBN.

      Abstract

      Background

      Acute focal bacterial nephritis (AFBN) is a complicated form of acute pyelonephritis (APN) characterized by single or multiple areas of localised infection in the kidney without liquefaction or abscess. Studies investigating AFBN in adults are scarce.

      Aim

      The present study was aimed at evaluating the prevalence, associated factors, and presence of atypical clinical and radiological manifestations in adult AFBN patients. Also, we developed a clinical prediction model to evaluate the probability of AFBN in patients with APN.

      Methods

      The clinical records of 377 patients (mean age 54 years, 74.0% females) admitted to a hospital over a 5-year period with APN were reviewed.

      Results

      A total of 57 cases of AFBN were radiologically identified (prevalence, 15.1%). Patients with AFBN were younger and displayed atypical manifestations more frequently than patients without AFBN; these included both clinical and radiological (pleural effusion, gallbladder wall thickening, fluid around the gallbladder, perirenal fluid, and ascites) manifestations. Patients with AFBN showed lower systolic blood pressure and needed more days of therapy to become afebrile, longer total duration of antibiotic therapy, and longer hospital stay than patients without AFBN. Contraceptive use was more frequent in patients with AFBN. A model based on five clinical variables showed good discrimination performance for the diagnosis of AFBN (Area under the curve, 0.77 (95% CI, 0.69–0.89)).

      Conclusions

      Patients with AFBN frequently present with atypical clinical and radiological manifestations. Clinical presentation by means of a predictive model may predict the presence of AFBN. Patients with AFBN need more intensive therapy, which is followed by a favourable outcome.

      Keywords

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