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Pyelonephritis, Pediatric

Christopher E. Bayne, MD and Michael H. Hsieh, MD, PhD Reviewed 10/2018
 


BASICS

DESCRIPTION

  • Acute pyelonephritis (APN; or upper urinary tract infection [UTI]) is a clinical diagnosis that may feature fever, positive urine culture, and urinary symptoms (e.g., dysuria, freque...

DIAGNOSIS

HISTORY

  • Fever may be the only presenting complaint.

  • In the neonate, inquire about vomiting, lethargy, poor feeding, irritability, fever, hypothermia, trembling, and jaundice

  • Older children are ...

TREATMENT

MEDICATION

  • Initiate broad-spectrum antibiotics. Children who appear toxic, dehydrated, <2 months, or vomiting should receive IV antibiotics until afebrile for at least 24 hours, then chang...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Educate caregivers on signs, symptoms of UTI, need for sterile urine specimen, and need for urgent medical attention.

  • If child has suffered sever...

ADDITIONAL READING

  • Morello W, La Scola C, Alberici I, et al. Acute pyelonephritis in children. Pediatr Nephrol.  2016;31(8):1253–1265. [View Abstract on OvidInsights]

  • National Institute for Health...

CODES

ICD9

  • 590.80 Pyelonephritis, unspecified

  • 590.10 Acute pyelonephritis without lesion of renal medullary necrosis

  • 590.00 Chronic pyelonephritis without lesion of renal medullary necrosis

  • 590.11 Acute p...

FAQ

  • Q: Should a DMSA scan be used to diagnose APN?

  • A: Routine use of the DMSA scan to diagnose APN is controversial because disagreement exists about the therapeutic implications of a positive test, an...

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