A guideline for the inpatient care of children with pyelonephritis.
OBJECTIVE
Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxic. The American Academy of Pediatrics (AAP) practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children provides experience and evidence-based guidelines for the practitioner caring for children between the ages of 2 months to 2 years. No established guideline exists for older children and the AAP guideline does not specifically focus on inpatient care.


METHODS
We conducted a comprehensive review of recently published literature and practice guidelines to develop a consensus on the inpatient diagnosis and management of children with pyelonephritis.


RESULTS
Eight recommendations are proposed for the diagnosis and management, including revised guidelines for the imaging studies postpyelonephritis on the basis of current best evidence.


CONCLUSIONS
Proper diagnosis of pyelonephritis, timely initiation of appropriate therapy and identification of children at risk for renal injury will help to reduce immediate as well as long-term complications due to chronic kidney disease.
Chishti
Aftab S
AS
Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA. aftab.chishti@uky.edu
Maul
Erich C
EC
Nazario
Rubén J
RJ
Bennett
Jeffrey S
JS
Kiessling
Stefan G
SG
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever; D005440:Fluid Therapy; D024841:Fluoroquinolones / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007297:Inpatients; D007674:Kidney Diseases / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D010406:Penicillins / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011704:Pyelonephritis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D013449:Sulfonamides / Q000627:therapeutic use; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D010406:Penicillins; D013449:Sulfonamides