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Journal of the Korean Society of Pediatric Nephrology 2004;8(2): 229-238.
소아 급성 세균성 신엽염의 임상상 및 신장 예후
이동기, 권덕근, 임윤주, 신윤혜, 윤석남, 배기수
1아주대학교 의과대학 소아과학교실
2아주대학교 의과대학 소아과학교실
3아주대학교 의과대학 소아과학교실
4아주대학교 의과대학 소아과학교실
5아주대학교 의과대학 핵의학과학교실
6아주대학교 의과대학 소아과학교실
Clinical Characteristics and Renal Outcomes of Acute Focal Bacterial Nephritis in Children
Dong-Ki Lee, Duck-Geun Kwon, Yun-Ju Lim, Yun-Hye Shin, Suk-Nam Yun, Ki-Soo Pai
1Departments of Pediatrics College of Medicine, Ajou University
2Departments of Pediatrics College of Medicine, Ajou University
3Departments of Pediatrics College of Medicine, Ajou University
4Departments of Pediatrics College of Medicine, Ajou University
5Departments of Nuclear Nledicine College of Medicine, Ajou University
6Departments of Pediatrics College of Medicine, Ajou University
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ABSTRACT
Purpose: This study was perfonned to elucidate the clinical pictures of acute focal bacterial nephritis(nephronia) in children.
Methods: We reviewed 9 children with nephronia diagnosed by ultrasonography or computed tomography of kidneys from September 1994 to August 2004.
Results : The overall male to female ratio was 2:1, and the age distribution ranged from 0.1 to 6 years(mean $2.8{pm}2.2$). The cardinal symptoms were fever, chills, abdominal pain and dysuria/frequency. The initial leukocyte count was $21,000{pm}5,600/uL$, ESR $60{pm}23mm/hr$, CRP $17{pm}10;mg/dl$. Pyuria was noted in every patient and persisted for $10.5{pm}7.8$ days after antimicrobial treatment. Abdominal sonography demonstrated focal lesion of ill-defined margin and low echogenicity in 5 of 9 patients(55.6%), while computed tomography revealed nonenhancing low density area in all patients(100%). Three of 9 patients(33.3%) had vesicoureteral reflux, greater than grade III. The initial $^{99m}Tc-DMSA$ scan showed one or multiple cortical defects in every patient, and improvements were noted in 2(33.3%) of 6 patients who received follow up scan after 4 months. Intravenous antibiotics was given in every patient under admission. Total febrile period was $11.8{pm}6.3$ days(pre-admission, $4.0{pm}3.0;$ post-admission, $7.8{pm}5.5$ days) and the patients needed hospitalization for $17.2{pm}8.1$ days.
Conclusion : For the early diagnosis of 'acute focal bacterial nephritis' we should perform renal computed tomography first rather than ultrasonography, when the child has toxic symptoms and severe inflammatory responses in blood and urine.
Key words: Nephronia | Acute focal bacterial nephritis | Children | Renal outcome | Renal computed tomography
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