Acute Pyelonephritis
Pyelonephritis is the inflammation of the upper urinary tract, involving the renal pelvis and parenchyma. Its prompt diagnosis is important in order to avoid both short- and long-term complications such as scarring of the kidneys, hypertension, and in som
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Alessandra Scionti, Piercarlo Rossi, Pietro Gulino, Alessandro Semeraro, Claudio Defilippi, and Michele Tonerini
17.1
Introduction
Pyelonephritis is the inflammation of the upper urinary tract, involving the renal pelvis and parenchyma. Its prompt diagnosis is important in order to avoid both short- and long-term complications such as scarring of the kidneys, hypertension, and in some unfortunate case even chronic renal insufficiency leading to a transplant. In pediatric patients, it usually migrates to the kidney from the bladder, being considered a continuum of disease from the lower to the upper urinary tract, while it is rarely seeded there hematogenously. In fact, the most frequent pathogens are the same causing infection of the lower tract; in particular Escherichia coli is responsible in over 80 % of urinary tract infections (UTIs) in children. Other common pathogens are Klebsiella, Proteus, Enterobacter, Streptococcus B, Enterococcus, and
A. Scionti • P. Rossi Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy P. Gulino • A. Semeraro • C. Defilippi Pediatric Radiology, Meyer University Children’s Hospital, Florence, Italy M. Tonerini (*) Department of Emergency Radiology, Cisanello University Hospital, Pisa, Italy e-mail: [email protected]
occasionally Pseudomonas. Mycotic infections are rarer in children than in adults (Bhat et al. 2011). The vast majority is maintained by gramnegative bacterial organism since they produce a virulent endotoxin causing inhibition of ureteral peristalsis by blocking the adrenergic nerves of the smooth muscle and thus facilitating their ascent to the kidney with adhesion fimbria, even in the absence of reflux (Goel et al. 2015). When the pathogen gets to the kidney, it causes a focal or diffuse acute inflammation of the tubules and the interstitium with consequent debris formation within the tubules that might result in impaired renal function.
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Risk Factors
Some children are more susceptible than others to UTI, and subsequently they might be more prone to develop pyelonephritis, recurrence, or complication. Their vulnerability might be due to anatomic or functional factors. Generally, in the first months of life, it is easy for neonates to contract UTI due to the immature immune system; after 6 months of age, girls have a higher risk of infections than boys because of anatomic characteristics, while debate has long been ongoing on circumcised males even if in 2012 the American Academy of Pediatrics (AAP) clearly stated the risk reduction of UTI after circumcision. Anatomic issues increasing the risk of UTI and
© Springer International Publishing Switzerland 2016 V. Miele, M. Trinci (eds.), Imaging Non-traumatic Abdominal Emergencies in Pediatric Patients, DOI 10.1007/978-3-319-41866-7_17
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A. Scionti et al.
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pyelonephritis are the ones causing obstruction to urine flow, consequent urinary stasis, and inadequate clearance of pathogens leading to bacterial overgrowth. Examples are urethral stricture, posterior u
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