• Clinical and Experimental Pediatrics
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• v.56 no.5
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• pp.218-223
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• 2013

Purpose: Early diagnosis and treatment of acute pyelonephritis in children is of special importance in order to prevent serious complications. This study was conducted to determine the diagnostic value of serum interleukin (IL)-6 and IL-8 in children with acute pyelonephritis. Methods: Eighty-seven patients between 1 month to 12 years old with urinary tract infection (UTI) were divided into 2 groups based on the result of 99m-technetium dimercapto-succinic acid renal scan: acute pyelonephritis (n=37) and lower UTI (n=50) groups. White blood cell (WBC) count, neutrophil (Neutl) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, platelet count, and serum IL-6 and IL-8 concentrations of both groups were measured and compared. Results: There was a significant difference between two groups regarding WBC count, Neutl count, ESR, and CRP concentration (P<0.05). In addition, the difference between the two groups regarding serum IL-6 and IL-8 concentrations was not significant (IL-6, 60 and 35.4 pg/mL and IL-8, 404 and 617 pg/mL, respectively). The sensitivity and specificity of serum IL-6 and IL-8 for diagnosis of acute pyelonephritis were 73%, 42% and 78%, 32%, respectively. Sensitivity, specificity, negative and positive predictive values of serum IL-6 and IL-8 were less than those of acute phase serum reactants such as CRP. Conclusion: This study showed that there was no significant difference between acute pyelonephritis and lower UTI groups regarding serum IL-6 and IL-8 levels. Therefore, despite confirming results of previous studies, it seems that IL-6 and IL-8 are not suitable markers for differentiating between acute pyelonephritis and lower UTI.

• The Korean Journal of Nuclear Medicine
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• v.23 no.2
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• pp.201-207
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• 1989

Patients with acute pyleonephritis may present with a spectrum of clinical symptoms and signs. There are few noninvasive diagnostic studies, however, to confirm or exclude this diagnosis. To evaluate the clinical utility of $^{99m}Tc-DMSA$ renal scan in diagnosis of acute pyelonephritis, we performed $^{99m}Tc-DMSA$ renal scan in 37 patients suspected with urinary tract infection. Simultaneously, kidney ultrasonography was done in 21 patients diagnosed with acute pyelonephritis, clinically. And we performed the followup scan after treatment in two to six weeks. The results were as follows: 1) $^{99m}Tc-DMSA$ renal scan disclosed single or multiple cortical defects and decreased radiouptake ratio of affected kidney in 23 patients among 25 patients diagnosed with acute pyleonephritis. 2) In the 21 patients with acute pyelonephritis, kidney ultrasonography showed abnormal finding in the 7 patients. And $^{99m}Tc-DMSA$ renal scan disclosed abnormal cortical defects in this 7 patients also. 3) Between the patients with acute pyelonephritis and those with lower urinary tract infection, asymptomatic bacteriuria or pyuria. right-to-left radiouptake ratios (R/L ratio) were significantly different (p < 0.001). 4) In two to six weeks after antibiotic therapy, we performed followup $^{99m}Tc-DMSA$ renal scan for 5 patients among 25 acute pyelonephritis patients. And we have found the improvement of cortical defects and the right-to-left radiouptake ratio. In conclusion, we thought that $^{99m}Tc-DMSA$ renal scan should be useful in diagnosis of acute pyelonephritis and follow-up examination.

• Childhood Kidney Diseases
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• v.6 no.2
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• pp.218-226
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• 2002

Purpose: The purpose of this study is to assess the ability of power Doppler sonography in the detection of acute pyelonephritis. Materials and Methods: We performed gray scale sonography, power Doppler sonography, and $^{Tc-99m}DMSA$ scintigraphy of the kidney in 80 patients with symptoms suggesting upper urinary tract infection. All imaging studies were obtained within 4 days. On $^{Tc-99m}DMSA$ scintigraphy, decreased radioactivity or photopenic lesions were considered indicative of acute pyelonephritis. Triangular areas of decreased perfusion identified on power Doppler sonography were considered as parenchymal lesions of acute pyelonephritis. The results of gray scale sonography and power Doppler sonography were retrospectively analysed and compared with those of $^{Tc-99m}DMSA$ scintigraphy which was given as the standards of reference. Results: For 40(85%) of the 47 patients with scintigraphy-proven acute pyelonephritis, power Doppler sonography diagnosed this condition on the correct side. The acute pyelonephritis which was not revealed by power Doppler sonography was observed in seven patients. Also, in three patients, false-positive indication of pyelonephritis was given by power Doppler sonography. Gray scale sonography showed positive findings in 23(49%) of 47 patients with positive findings on scintigraphy. Conclusion: Power Doppler sonography seems to be less sensitive than $^{Tc-99m}DMSA$ DMSA scintigraphy but significantly more sensitive than gray scale sonography for the detection of acute pyelonephritis in children. Power Doppler sonography shows promise as a noninvasive means of assessing renal cortical perfusion in children with clinically suspected acute pyelonephritis.

• Journal of Physiology & Pathology in Korean Medicine
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• v.19 no.6
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• pp.1706-1709
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• 2005

This is a clinical report of an aspect Soyangyangmyunghabbyung patient with acute pyelonephritis. One patient who had headache, fever, chilling sign, nausea and constipation was treat. The symptoms have relation to Soyangyangmyunghabbyung(少陽陽明合病) of Yugkyeung(六經) thee. On the basis of this thee, we performed the treatment on acute pyelonephritis. We treated her with Herbal medicine(Daeshihotanggami, Bojungikgitanggami) and acupuncture(Ganjeonggyeok). As the result of our treatment, we were experiencef an improved case of acute pyelonephritis patient.

• Kosin Medical Journal
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• v.33 no.3
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• pp.337-346
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• 2018

Objectives: Serum procalcitonin (PCT) is a specific biomarker that rises after bacterial infection, and levels of PCT are known to correlate with the severity and mortality of patients with pneumonia and sepsis. However, the usefulness of PCT levels in acute pyelonephritis is unknown. This study aimed to evaluate the effectiveness of using the PCT level as a predictive test for bacteremia in acute pyelonephritis. Methods: Between January 2012 and June 2013, 140 patients diagnosed with acute pyelonephritis were admitted to Haeundae Paik Hospital. Serum PCT, C-reactive protein (CRP), and white blood cell (WBC) levels at pre- and post- treatment were measured. Blood and urine cultures were obtained from all patients. The levels of PCT, CRP, and WBCs were each compared between the blood culture-positive and blood culture-negative groups to assess their effectiveness in predicting bacteremia. Results: Pre-treatment PCT level was 0.77 ng/mL (95% CI: 0.42-1.60 ng/mL) in the blood culture-negative group and 4.89 ng/mL (95% CI: 2.88-9.04 ng/mL) in the blood culture-positive group, and the increase between the two groups was statistically significant. The area under the receiver operating characteristic curve of PCT level for prediction of bacteremia was 0.728. A cut-off value of 1.23 ng/mL indicated a sensitivity of 79.0 % and specificity of 60.0 % for PCT level. Conclusions: Serum PCT level is a useful predictive test for bacteremia in acute pyelonephritis. Through the early detection of bacteremia, serum PCT level can help estimate the prognosis and predict complications such as sepsis.

• Childhood Kidney Diseases
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• v.19 no.2
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• pp.79-88
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• 2015

Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as one of the most promising biomarkers of renal epithelial injury. Numerous studies have presented the diagnostic and prognostic utility of urinary and plasma NGAL in patients with acute kidney injury, chronic kidney disease, renal injury after kidney transplantation, and other renal diseases. NGAL is a member of the lipocalin family that is abundantly expressed in neutrophils and monocytes/macrophages and is a mediator of the innate immune response. The biological significance of NGAL to hamper bacterial growth by sequestering iron-binding siderophores has been studied in a knock-out mouse model. Besides neutrophils, NGAL is detectable in most tissues normally encountered by microorganisms, and its expression is upregulated in epithelial cells during inflammation. A growing number of studies have supported the clinical utility of NAGL for detecting invasive bacterial infections. Several investigators including our group have reported that measuring NGAL can be used to help predict and manage urinary tract infections and acute pyelonephritis. This article summarizes the biology and pathophysiology of NGAL and reviews studies on the implications of NGAL in various renal diseases from acute kidney injury to acute pyelonephritis.

• Childhood Kidney Diseases
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• v.10 no.2
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• pp.244-248
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• 2006

Shigella infection usually produces gastrointestinal symptoms but rarely causes urinary tract infection. A 7-year-old girl was admitted for fever, chills, right flank pain, and dysuria. She had no vomiting or diarrhea. There was mild tenderness in her right lower abdomen, and right CVA tenderness was also noted. Acute pyelonephritis was diagnosed by abdominal CT. She showed improvement with intravenous administration of antibiotics. The first urine culture grew $1{\times}10^5$ CFU/mL Shigella dysenteri. Although urinary tract infections due to Shigella species are extremely rare, Shigella species should be considered as a possible cause of pediatric urinary tract infection. We report the first case of urinary tract infection caused by S. dysenteri, which presented as acute pyelonephritis without gastrointestinal symptoms in a child.

• Childhood Kidney Diseases
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• v.20 no.2
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• pp.74-78
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• 2016

Purpose: Early diagnosis and treatment of urinary tract infection have been emphasized to prevent renal scarring. If untreated, acute pyelonephritis could cause renal injury, which leads to renal scarring, hypertension, proteinuria, and chronic renal failure. The purpose of this study was to assess risk factors of renal scarring after treatment of acute pyelonephritis (APN). Methods: The medical records of 59 patients admitted at Daegu Fatima Hospital because of APN between March 2008 and April 2015 whose renal cortical defects were confirmed by using initial technetium-99m dimercaptosuccinic acid (DMSA) scans were reviewed retrospectively. We divided 59 patients into 2 groups according to the presence of renal scar and assessed risk factors of renal scar, including sex, age at diagnosis, feeding method, hydronephrosis, bacterial species, vesicoureteral reflux, and vesicoureteral reflux grade. Results: Of 59 patients (41%), 24 showed renal scar on follow-up DMSA scan. No significant differences in sex, hydronephrosis, bacterial species, and fever duration were found between the renal-scarred and non-scarred groups. As for age at diagnosis, age of >12 months had 5.8 times higher incidence rate of renal scarring. Vesicoureteral reflux (VUR) affected renal scar formation. VUR grade III or IV had 14.7 times greater influence on renal scar formation than VUR grade I or II. Conclusion: Our data suggest that the presence of VUR and its grade and age at diagnosis are risk factors of renal scar on follow-up DMSA scan after APN.

• Journal of Sasang Constitutional Medicine
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• v.13 no.2
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• pp.194-204
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• 2001

Purpose: In general, Acute Pyelonephritis is effectively treated with the use of antibiotics. However, some antibiotics are reported to cause side effects, and the abuse of antibiotics results in the increase of the disease's tolerance to antibiotics. Recently, I have effectively treated five cases of Acute Pyelonephritis by using only Constitution - Acupuncture and Herb, and therefore I would like to report about these cases. Methods: I diagnosed Acute Pyelonephritis of these five patients by confirming symptoms and employing a urine analysis with reagent strip(Multi $stix{\circledR}$). I used Kuon's method of constitutional diagnosis for the purpose of the diagnosis of the constitutional 8 morbidities. I relied on Sungjeong(性情) and Chehyungkisang(體刑氣像) in diagnosing Sasang Constitutions(四象人). I performed acupuncture on the left and right sides, depending on 8 constitutions, by employing Chang - temperament Inflammation Formula(臟系炎症方) that is used for the treatment of all kinds of chang-temperament inflammation diseases, as well as Bactericidal Formula(殺菌方) that is used for the treatment of all kinds of bacterially caused diseases. I prescribed by consulting the appearance of disease and general symptoms of each case with Dongyi Soose Bowon(東醫壽世保元)'s prescription symptoms. Result: Two of them showing severe symptoms were hospitalized, while three others took OPD treatment. The patient who was PANCREOTONIA and Soyangin improved through hospitalization for three days, another patient who was PULMOTONIA and Taeyangin with severe symptoms, improved through hospitalization for seven days, and completely recovered through OPD treatment later. The three others took only OPD treatment, and improved within 5-7 days. Conclusion: I confirmed that each of 8-constituions and Sasang Constitutions were all treated effectively without antibiotics.

• Clinical and Experimental Pediatrics
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• v.62 no.12
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• pp.433-437
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• 2019

Acute pyelonephritis (APN) should be detected and treated as soon as possible to reduce the risk of the development of acquired renal scarring. However, in the medical field, urine culture results are not available or considered when the prompt discrimination of APN is necessary and empirical treatment is started. Furthermore, urine culture cannot discriminate APN among children with febrile urinary tract infection (UTI) (pyelitis, lower UTI with other fever focus). Therefore, the usefulness of urine culture for diagnostic purposes is small and the sampling procedure is invasive. Congenital hypoplastic kidney is the most common cause of chronic kidney injury in children. Thus, it is desirable that a main target be detected as early as possible when imaging studies are performed in children with APN. However, if APN does not recur, no medical or surgical treatment or imaging studies would be needed because the acquired renal scar would not progress further. Therefore, the long-term prognosis of APN in young children, particularly infants, depends on the number of recurrent APN, not other febrile UTI. New methods that enable prompt, practical, and comfortable APN diagnosis in children are needed as alternatives to urinary catheterization for urine culture sampling.