Abstract
Background: Acute lobar nephronia (ALN) or acute focal nephritis is a little-known complication of an infectious process of the urinary tract, with a focal, acute and non-suppurative nature, which affects one or more renal lobes; its pathogenesis is generally ascending, its clinical manifestations are insidious and imaging support is necessary for its diagnosis, it requires a targeted and prolonged antibiotic treatment, its prognosis depends on its suspicion and adequate therapy, but above all timely and early. The case of a 9-month-old infant treated in an institution in Bogotá (Colombia) is presented.
Purpose: Since the case of a pathology with low incidence and limited literature is described, due to its low prevalence in both children and adults, the aim of this article was to perform a case report and a literature search review of this topic in scientific databases such as PubMed, Embase, Science Direct and Lilacs, to increase the available information on ALN in an infant.
Case presentation: A case of acute lobar nephronia is presented in a 9-month-old patient with a complicated urinary tract infection that remained symptomatic despite management. A focal right renal mass was subsequently detected by ultrasound, which was later characterized by computed tomography, and had complete resolution after treatment with antibiotics for 14 days.
Discussion and conclusion: Acute focal nephritis (NLA) is a complication of urinary tract infections. It is characterized by renal inflammation without areas of liquefaction and necrosis, unlike renal abscess, and its pathophysiology is associated with bacterial ascension to the kidney. Although its diagnosis can be complicated by its similarity to other conditions such as Wilms tumor, ultrasound and CT are key to differentiate it. The mainstay of treatment is antimicrobial therapy directed according to microbiological isolation and rarely requires surgical intervention.
NLA is a rare pathology in children, with variable and nonspecific clinical presentation. Clinical and paraclinical characteristics and mainly imaging findings that suggest NLA must be taken into account for its diagnosis to facilitate timely treatment and thus reduce the risk of short- and long-term complications.
References
Sheu JN. Acute lobar nephronia in children. Pediatr Neonatol. 2015;56(3):141-2. https://doi.org/10.1016/j.pedneo.2015.03.001
Vijayakumar M, Prahlad N, Nandhini G, Prasad N, Muralinath S. Child with acute lobar nephronia. Indian J Nephrol. 2010;20(3):162-5. https://doi.org/10.4103/0971-4065.70847
Granados Molina A, Espino Hernández M, Gancedo Baranda A, Albillos Merino JC, Álvarez-Cortinas JF, Molina Amores C. Nefronía focal aguda bacteriana: diagnóstico, tratamiento y evolución. An Pediatr. 2007;66(1):84-6. https://doi.org/10.1157/13097366
Rathore MH, Barton LL, Luisiri A. Acute lobar nephronia: a review. Pediatrics. 1991;87(5):728-34. https://doi.org/10.1542/peds.87.5.728
Rosenfield AT, Gilckman MG, Taylor KJ, Crade M, Hodson J. Acute focal bacterial nephritis (acute lobar nephronia). Radiology. 1979;132(3):553-61. https://doi.org/10.1148/132.3.553
Yang CC, Shao PL, Lu CY, Tsau YK, Tsai IJ, Lee PI, et al. Comparison of acute lobar nephronia and uncomplicated urinary tract infection in children. J Microbiol Immunol Infect. 2010;43(3):207-14. https://doi.org/10.1016/s1684-1182(10)60033-3
Criado Pacheco J, De la Cruz Moreno J. Nefronía lobar. Rev Salud UIS. 1993;21(1):63-6.
Barragan Arévalo V, Mancera Morales J, Echeverri Restrepo V, Niño Salcedo J, Luengas Monroy JP. Nefronía lobar aguda en el paciente pediátrico. Reporte de caso. Pediatría. 2023;55(supl. 2):3-6. https://doi.org/10.14295/rp.v55iSuplemento2.259
Chen WL, Huang IF, Wang JL, Hung CH, Huang JS, Chen YS, et al. Comparison of acute lobar nephronia and acute pyelonephritis in children: a single-center clinical analysis in Southern Taiwan. Pediatr Neonatol. 2015;56(3):176-82. https://doi.org/10.1016/j.pedneo.2014.08.002
Gomez-Piña JJ, Flores-Azmar AM. Tumor de Wilms. Med Int Méx. 2019;35(1):177-82. https://doi.org./10.24245/mim.v35i1.2110
Piñera C, Loyola F, Hernández P. Nefronía en pediatría: dentro del espectro de las infecciones urinarias. Serie clínica y revisión de la literatura. Rev Chil Infectol. 2015;32(5):564-8. http://dx.doi.org/10.4067/S0716-10182015000600011
Jiao S, Yan Z, Zhang C, Li J, Zhu J. Clinical features of acute focal bacterial nephritis in adults. Sci Rep. 2022;12:7292. https://doi.org/10.1038/s41598-022-10809-5
Lucas García J, Oltra Benavent M, Ferrando Monleón S, Marín Sierra J, Rabasco Álvarez MD, Benito Julve P, et al. Marcadores predictivos de nefritis focal bacteriana aguda. Estudio multicéntrico de casos-control. An Pediatr. 2020;93(2):77-83. https://doi.org/10.1016/j.anpedi.2020.01.018
Kusama Y, Muraki K. Bilateral multifocal acute lobar nephronia caused by Enterococcus faecalis. BMJ Case Rep. 2018; bcr-2018-224336. https://doi.org/10.1136/bcr-2018-224336
Cheng CH, Tsau YK, Lin TY. Effective duration of antimicrobial therapy for the treatment of acute lobar nephronia. Pediatrics. 2006;117(1):e84-9. https://doi.org/10.1542/peds.2005-0917
Cheng C. Case 33. An 8-month-old female infant with fever and pyuria: acute lobar nephronia. En: Huang YC, Lee PI, Chen PY, editores. Paediatric infectious diseases, a practical guide and cases. Singapur: Springer; 2023. https://doi.org/10.1007/978-981-19-7276-8_33

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.